Русский
Pathogenetic features of the development and progression of heart damage in COVID-19
DOI: https://dx.doi.org/10.18565/epidem.2022.12.2.20-7
Ageikin A.V., Usenko D.V., Gorelov A.V., Kurmaeva D. Yu., Melnikov V.L., Kolesova E.V.
1) Penza State University, Penza, Russia; 2) Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia; 3) Penza Regional Clinical Center for Specialized Medical Care, Penza, Russia; 4) Penza District Hospital, Penza, Russia; 5) A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia
Subjects and methods. Clinical and laboratory parameters were analyzed in 180 patients who had received inpatient treatment for diagnosed and confirmed moderate novel coronavirus disease (COVID-19) and had no history of cardiac disease. In addition to the standard laboratory examination, the levels of biochemical, immunological, and cardiac markers, such as IFN-α, IL-6, IL-17, macrophage inflammatory protein (MIP-1β), brain natriuretic peptide (NT-proBNP), troponin I, fatty acid binding protein, and C-reactive protein were studied over time.
Results. On days 7 to 10 after illness onset, the patients with moderate COVID-19 were found to have elevated levels of the markers of myocardial damage [troponin I (53.3%), fatty acid binding protein (8.8%)] and myocardial dysfunction [NT-proBNP (45%)]. By the 2nd week of hospitalization, the number of patients with the elevated level of troponin I increased up to 68.3% and that of NT-proBNP decreased to 26.7%. There was a direct correlation between the increase in the above markers with the levels of IL-6 and IL-17, as well as with the concentration of MIP-1β and there was an inverse correlation with the level of IFN-α. ECG revealed signs of myocardial ischemia, cardiac hypertrophy and overload, and arrhythmia. At 3 months after recovery, 20% of the examinees complained of heart area pains that were not recorded before COVID-19, of whom 58.3% of patients were noted to have a pretest probability of 15–85% for CHD, which justifies the need for additional cardiac imaging tests after COVID-19 infection.
Conclusion. Comprehensive analysis of clinical complaints, biochemical and immunological parameters, and ECG and echocardiography data in patients with moderate COVID-19 could diagnose the development of acute myocardial damage in 43.8%, exertional angina pectoris in 11.2%, arrhythmia in 27%, and heart failure in 14.7%.
Literature
1. Mahajan S., Caraballo C., Li Shu-Xia, Dong C., Chen L., Huston S.K. et al. SARS-CoV-2 infection hospitalization rate and infection fatality rate among the non-congregate population in Connecticut. Am. J. Med. 2021; 134: 812–6. DOI: 10.1101/2020.10.30.20223461 2. Petersen E., Koopmans M., Unyeong G., Hamer D.H., Petrosillo N., Castelli F. et al. Comparing SARS-CoV-2 with SARS-CoV and influenza pandemics. Lancet Infect. Dis. 2020; 20: e238–44. DOI: 10.1016/S1473-3099(20)30484-9 3. Wiersinga W.J., Rhodes A., Cheng A.C., Peacock S.J., Prescott H.C. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review. JAMA 2020; 324: 782–93. DOI: 10.1001/jama.2020.12839 4. Фисун А.Я., Лобзин Ю.В., Черкашин Д.В., Тыренко В.В., Ткаченко К.Н., Качнов В.А. и др. Механизмы поражения сердечно-сосудистой системы при COVID-19. Вестник РАМН 2021; 76(3): 287–97. DOI: https://doi.org/10.15690/vramn1474 Fisun A.Ya., Lobzin Yu.V., Cherkashin D.V., Tyrenko V.V., Tkachenko K.N., Kachnov V.A. et al. [Mechanisms of damage to the cardiovascular system in COVID-19]. Bulletin of RAMN 2021; 76(3): 287–97. (In Russ.). DOI: https://doi.org/10.15690/vramn1474 5. Huang C., Wang Y., Li X., Ren L., Zhao J., Hu Y. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395(10223): 497–506. DOI: 10.1016/S0140-6736(20)30183-5 6. Pellicori P., Zhang J., Cuthbert J., Urbinati A., Shah P., Kazmi S. et al. High-sensitivity C-reactive protein in chronic heart failure: patient characteristics, phenotypes, and mode of death. Cardiovasc Res. 2020; 116: 91–100. DOI: 10.1093/cvr/cvz198 7. Giamarellos-Bourboulis E.J., Netea M.G., Rovina N., Akinosoglou K., Antoniadou A., Antonakos N. Complex immune dysregulation in COVID-19 patients with severe respiratory failure. Cell Host. Microbe 2020; 27: 992–3. DOI: 10.1016/j.chom.2020.04.009 8. Vabret N., Britton G.J., Gruber C., Hegde S., Kim J., Kuksin M. Immunology of COVID-19: current state of the science. Immunity 2020; 52: 910–41. DOI: 10.1016/j.immuni.2020.05.002 9. Aslani M., Mortazavi-Jahromi S.S., Mirshafiey A. Cytokine storm in the pathophysiology of COVID-19: Possible functional disturbances of miRNAs. Int. Immunopharmacol. 2021; 101. DOI: 10.1016/j.intimp.2021. 108172 10. Liu P.P., Blet A., Smyth D., Li H. The Science Underlying COVID-19: Implications for the Cardiovascular System. Circulation 2020; 142(1): 68–78. DOI: 10.1161/CIRCULATIONAHA.120.047549 11. Inciardi R.M., Lupi L., Zaccone G., Italia L., Raffo M., Tomasoni D. et al. Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020; 5(7): 819–24. DOI: 10.1001/jamacardio.2020.1096 12. Shi S., Qin M., Shen B., Cai Y., Liu T., Yang F. et al. Association of Cardiac Injury with Mortality in Hospitalized Patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020; 5(7): 802–10. DOI: 10.1001/jamacardio.2020.0950 13. Chapman A.R., Bularga A., Mills N.L. High-Sensitivity Cardiac Troponin Can Be an Ally in the Fight Against COVID-19. Circulation 2020; 141(22): 1733–5. DOI: 10.1161/CIRCULATIONAHA.120.047008 14. Liu Y., Li J., Feng Y. Critical care response to a hospital out-break of the 2019-nCoV infection in Shenzhen, China. Crit Care 2020; 24(1): 56. DOI: 10.1186/s13054-020-2786-x 15. Клинические рекомендации Российского кардиологического общества «Стабильная ишемическая болезнь сердца». 2020 г. https://scardio.ru/content/Guidelines/2020/Clinic_rekom_IBS.pdf [Clinical guidelines of the Russian Society of Cardiology «Stable coronary heart disease», 2020]. (In Russ.). https://scardio.ru/content/Guidelines/ 2020/Clinic_rekom_IBS.pdf
About the Autors
Aleksey V. Ageikin, Assistant Lecturer, Department of Microbiology, Epidemiology, and Infectious Diseases, Penza State University, Penza, Russia; Junior Researcher, Clinical Department of Infectious Pathology, Central Research Institute of Epidemiology of Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia; AgeykinAV@yandex.ru; meib@pnzgu.ru; http://orcid.org/0000-0001-5092-4744
Denis V. Usenko, MD, Leading Researcher, Clinical Department of Infectious Pathology, Central Research Institute of Epidemiology of Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia; dusenko@rambler.ru; http://orcid.org/0000-0001-5232-7337
Professor Alexander V. Gorelov, MD, Academician of the Russian Academy of Sciences, Deputy Director for Research, Central Research Institute of Epidemiology of Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being; Head, Department of Infectious Diseases and Epidemiology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia; agorelov_05@mail.ru; http://orcid.org/ 0000-0002-6446-2744
Dzhamilya Yu. Kurmaeva, Cand. Med. Sci., Deputy Head Physician for Treatment, Penza Regional Clinical Center for Specialized Medical Care, Penza, Russia; d.kurmaeva@yandex.ru
Viktor L. Melnikov, MD, Associate Professor, Head, Department of Microbiology, Epidemiology, and Infectious Diseases, Penza State University, Penza, Russia; v88794407@yandex.ru; http://orcid.org/0000-0002-2175-5547
Elena V. Kolesova, Head, Organization and Guidance Department, Penza District Hospital, Penza, Russia; gannover2016@gmail.com
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