JACC Focus Seminar: Coronavirus Disease 2019 in 2020
JACC Focus Seminar
Coronavirus and Cardiovascular Disease, Myocardial Injury, and Arrhythmia: JACC Focus Seminar

https://doi.org/10.1016/j.jacc.2020.08.059Get rights and content
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Highlights

  • The cardiovascular system is affected in diverse ways by severe acute respiratory syndrome coronavirus 2 infection (COVID-19).

  • Myocardial injury can be detected in ∼25% of hospitalized patients with COVID-19 and is associated with an increased risk of mortality.

  • Described mechanisms of myocardial injury in patients with COVID-19 include oxygen supply–demand imbalance, direct viral myocardial invasion, inflammation, coronary plaque rupture with acute myocardial infarction, microvascular thrombosis, and adrenergic stress.

Abstract

The cardiovascular system is affected broadly by severe acute respiratory syndrome coronavirus 2 infection. Both direct viral infection and indirect injury resulting from inflammation, endothelial activation, and microvascular thrombosis occur in the context of coronavirus disease 2019. What determines the extent of cardiovascular injury is the amount of viral inoculum, the magnitude of the host immune response, and the presence of co-morbidities. Myocardial injury occurs in approximately one-quarter of hospitalized patients and is associated with a greater need for mechanical ventilator support and higher hospital mortality. The central pathophysiology underlying cardiovascular injury is the interplay between virus binding to the angiotensin-converting enzyme 2 receptor and the impact this action has on the renin-angiotensin system, the body’s innate immune response, and the vascular response to cytokine production. The purpose of this review was to describe the mechanisms underlying cardiovascular injury, including that of thromboembolic disease and arrhythmia, and to discuss their clinical sequelae.

Key Words

arrhythmia
COVID-19
myocardial injury
SARS-CoV-2
thrombosis

Abbreviations and Acronyms

ACE2
angiotensin-converting enzyme 2
ADAM-17
a disintegrin and metalloproteinase domain 17
Ang
angiotensin
ARDS
acute respiratory distress syndrome
CI
confidence interval
CMR
cardiac magnetic resonance
COVID-19
coronavirus disease 2019
CVD
cardiovascular disease
CYP
cytochrome P450
DVT
deep venous thrombosis
HCQ
hydroxychloroquine
hERG
human ether-a-go-go related gene
IL
interleukin
MI
myocardial infarction
OR
odds ratio
RNA
ribonucleic acid
SARS
severe acute respiratory syndrome
SARS-CoV-2
severe acute respiratory syndrome coronavirus 2
STEMI
ST-segment elevation acute myocardial infarction
TMPRSS2
transmembrane serine protease 2
TNF
tumor necrosis factor

Cited by (0)

Dr. Giustino has received consulting fees from Bristol Myers Squibb and Pfizer. Dr. Pinney has received consulting fees from Abbott, CareDx, Medtronic, and Procyrion. Dr. Lala has received speaker honoraria from Zoll, Inc. Dr. Reddy has served as a consultant for Abbott, Ablacon, Acutus Medical, Affera, Apama Medical, Aquaheart, Autonomix, Axon, Backbeat, BioSig, Biosense-Webster, Biotronik, Boston Scientific, Cardiofocus, Cardionomic, CardioNXT/AFTx, Circa Scientific, Corvia Medical, Dinova Nuomao, East End Medical, EBR, EPD, Epix Therapeutics, EpiEP, Eximo, Farapulse, Fire1, Impulse Dynamics, Javelin, Keystone Heart, LuxCath, Medlumics, Medtronic, Middlepeak, Nuvera, Philips, Stimda, Thermedical, Valcare, and VytronUS; and has equity in Ablacon, Acutus Medical, Affera, Apama Medical, Aquaheart, Autonomix, Backbeat, BioSig, Circa Scientific, Corvia Medical, Dinova Nuomao, East End Medical, EPD, Epix Therapeutics, EpiEP, Eximo, Farapulse, Fire1, Javelin, Keystone Heart, LuxCath, Manual Surgical Sciences, Medlumics, Middlepeak, Newpace, Nuvera, Surecor, Valcare, Vizara, and VytronUS (none relevant to the current paper). Dr. Mechanick has received honoraria for lectures and program development from Abbott Nutrition. Dr. Halperin has received consulting fees from Bayer AG HealthCare, Boehringer Ingelheim, Johnson & Johnson, and Ortho-McNeil-Janssen Pharmaceuticals; and has served as a member of the Executive Steering Committee for the MARINER trial comparing anticoagulant strategies. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Muthiah Vaduganathan, MD, served as Guest Associate Editor for this paper. Deepak L. Bhatt, MD, MPH, served as Guest Editor-in-Chief for this paper.

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