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Previous and First Detected Cardiovascular Diseases in Patients with New Coronavirus Pneumonia: Possible Mechanisms
Olga V Blagova1, Nadezhda V Varionchik1, Vladimir A Zaidenov2
1The First I.M. Sechenov Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
Insights
Cardiovascular pathology is common in COVID-19 patients and linked to higher mortality. Elevated anti-heart antibodies suggest inflammatory heart injury, with D-dimer indicating prothrombotic mechanisms.
Area of Science:
- Cardiology
- Infectious Diseases
- Immunology
Background:
- Coronavirus disease 2019 (COVID-19) can affect multiple organ systems.
- Cardiac involvement in COVID-19 is a significant concern, impacting patient outcomes.
- Understanding the mechanisms of myocardial injury is crucial for effective management.
Purpose of the Study:
- To determine the frequency of cardiac involvement in COVID-19 patients.
- To investigate potential immune mechanisms, such as anti-heart antibodies (AHA), contributing to myocardial injury.
- To assess the prognostic significance of cardiovascular pathology in COVID-19.
Main Methods:
- Retrospective analysis of 86 COVID-19 patients.
- Assessment of cardiac biomarkers including troponin T and anti-heart antibodies (AHA).
- Correlation analysis of cardiac findings with clinical parameters, inflammatory markers, and mortality.
Main Results:
- 45.3% of patients exhibited cardiovascular disease or symptoms, including arrhythmias and heart failure.
- Elevated AHA levels were observed in 73.5% of tested patients and correlated with inflammatory activity and mortality.
- Cardiovascular pathology was associated with significantly higher lethality (17.9% vs. 2.2%) and was a cause of death in 37.5% of fatal cases.
Conclusions:
- Cardiovascular pathology is a frequent complication of COVID-19, strongly correlating with D-dimer levels, suggesting prothrombotic and ischemic mechanisms.
- High AHA levels may indicate inflammatory heart injury in COVID-19 patients.
- The presence of cardiovascular pathology significantly increases the risk of mortality in COVID-19.
Purpose:
The aim of this study is to evaluate the frequency of cardiac involvement in patients with coronavirus disease 2019 (COVID-19), possible immune mechanisms of myocardial injury, and the place of cardiovascular pathology among other prognostic factors.
Methods:
The study included 86 patients (48 male, 60.2 ± 16.6 years) with COVID-19. In addition to common investigation, examination of troponin T (n = 18) and anti-heart antibodies (AHA, n = 34) were used. The average hospital period was 14 [12; 18] days.
Results:
The incidence of cardiovascular disease and symptoms was 45.3%. Arrhythmias, heart failure, low-QRS voltage, repolarization disorders, and pericardial effusion were the typical for coronavirus cardiac injury. The level of AHA was increased in 73.5%. Significant (p < 0.05) correlations of AHA level with inflammatory activity, pneumonia, respiratory failure, cardiac symptoms, and death were found. D-dimer >0.5 μg/mL had a sensitivity of 79.2% and specificity of 60% in the prediction of cardiovascular manifestations. Cardiac failure was one of the causes of death in 3/8 patients (37.5%). Lethality in the presence of cardiovascular pathology was 17.9 versus 2.2% without it, p < 0.05. The most powerful prognostic model includes age, diabetes, oxygen therapy volume, maximum leukocyte level, C-reactive protein, and D-dimer (correlation coefficient 0.871, p < 0.001). The model with only age, diabetes, and cardiovascular disease included also had predictive power (correlation coefficient 0.568, p < 0.001).
Conclusions:
The cardiovascular pathology is frequent in patients with COVID-19 and strong correlates with the D-dimer. It indicates the high significance of prothrombotic and ischemic mechanisms. High AHA levels may reflect an inflammatory heart injury. The cardiovascular pathology is associated with higher lethality.
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