McGovern Medical School, Department of Medicine, University of Texas Health Science Center at Houston, Houston.
Texas Heart Institute, Houston.
JAMA Cardiol. 2020 Jul 1;5(7):831-840. doi: 10.1001/jamacardio.2020.1286.
IMPORTANCE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19) has reached a pandemic level. Coronaviruses are known to affect the cardiovascular system. We review the basics of coronaviruses, with a focus on COVID-19, along with their effects on the cardiovascular system. OBSERVATIONS: Coronavirus disease 2019 can cause a viral pneumonia with additional extrapulmonary manifestations and complications. A large proportion of patients have underlying cardiovascular disease and/or cardiac risk factors. Factors associated with mortality include male sex, advanced age, and presence of comorbidities including hypertension, diabetes mellitus, cardiovascular diseases, and cerebrovascular diseases. Acute cardiac injury determined by elevated high-sensitivity troponin levels is commonly observed in severe cases and is strongly associated with mortality. Acute respiratory distress syndrome is also strongly associated with mortality. CONCLUSIONS AND RELEVANCE: Coronavirus disease 2019 is associated with a high inflammatory burden that can induce vascular inflammation, myocarditis, and cardiac arrhythmias. Extensive efforts are underway to find specific vaccines and antivirals against SARS-CoV-2. Meanwhile, cardiovascular risk factors and conditions should be judiciously controlled per evidence-based guidelines.
重要性:导致 2019 年冠状病毒病(COVID-19)的严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)已达到大流行水平。众所周知,冠状病毒会影响心血管系统。我们回顾了冠状病毒的基础知识,重点介绍了 COVID-19 及其对心血管系统的影响。
观察结果:COVID-19 可引起病毒性肺炎,并伴有肺外表现和并发症。很大一部分患者存在潜在的心血管疾病和/或心脏危险因素。与死亡率相关的因素包括男性、高龄以及合并症,包括高血压、糖尿病、心血管疾病和脑血管疾病。在严重病例中,通常会观察到由高敏肌钙蛋白水平升高确定的急性心脏损伤,并且与死亡率密切相关。急性呼吸窘迫综合征也与死亡率密切相关。
结论和相关性:COVID-19 与高炎症负担相关,可引起血管炎症、心肌炎和心律失常。目前正在大力寻找针对 SARS-CoV-2 的特异性疫苗和抗病毒药物。同时,应根据循证指南谨慎控制心血管危险因素和疾病。
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