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Correlation between structural heart disease and cardiac SARS-CoV-2 manifestations
Felix Nägele1, Michael Graber1, Jakob Hirsch1
1Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria.
Communications Medicine
|November 12, 2022
Summary
Structural heart disease (SHD) increases COVID-19 patient risk. Myocardial SARS-CoV-2 presence correlates with SHD and worse survival, suggesting SHD is a risk factor for severe COVID-19.
Area of Science:
- Cardiology
- Infectious Diseases
- Virology
Background:
- COVID-19 prognosis is poor for patients with cardiac involvement.
- The SARS-CoV-2 virus utilizes the ACE2 receptor for cell entry.
- Myocardial ACE2 expression is elevated in patients with structural heart disease (SHD).
Purpose of the Study:
- To investigate the correlation between structural heart disease and cardiac manifestation of SARS-CoV-2.
- To identify risk factors for severe COVID-19 in patients with cardiac involvement.
Main Methods:
- Prospective cohort study of 152 COVID-19 patients assessing clinical course, hospitalization, and survival.
- Autopsy analysis of cardiac tissue from 23 lethal COVID-19 cases.
- Analysis included presence of SHD, myocardial SARS-CoV-2 via RT-PCR, and ACE2 expression levels.
Main Results:
- SHD was present in 67 patients, with 83.60% requiring hospitalization.
- Myocardial SARS-CoV-2 was detected in 65% of autopsy cases, predominantly in those with SHD (91.67%).
- Myocardial SARS-CoV-2 presence correlated with significantly downregulated ACE2 expression and impaired survival (HR 0.30, p=0.0005).
Conclusions:
- Evidence supports a correlation between SHD, altered ACE2 expression, and cardiac SARS-CoV-2 manifestation.
- Structural heart disease is identified as a distinct risk factor for severe COVID-19 clinical course.
- These findings highlight the importance of considering cardiac status in COVID-19 risk assessment.
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