Cardiovascular Disease, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
Cardiovascular Disease, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA.
J Investig Med. 2020 Dec;68(8):1334-1340. doi: 10.1136/jim-2020-001592. Epub 2020 Oct 19.
COVID-19 has posed an extraordinary burden on health and the economy worldwide. Patients with cardiovascular diseases are more likely to have severe illness due to COVID-19 and are at increased risk for complications and mortality. We performed a narrative literature review to assess the burden of COVID-19 and cardiovascular morbidity and mortality. Myocardial injury has been reported in 20%-30% of patients hospitalized due to COVID-19 and is associated with a worse prognosis and high mortality (~50%-60%). Proposed mechanisms of myocardial injury include inflammation within the myocardium (due to direct viral infection or cytokine storm), endotheliitis, coronary vasculitis, myocarditis, demand ischemia, plaque destabilization and right ventricular failure. The right ventricle is particularly vulnerable to injury and failure in COVID-19-infected patients, given the hypoxic pulmonary vasoconstriction, pulmonary microthrombi or pulmonary embolism. Echocardiography is an effective and accessible tool to evaluate left and right ventricular functions and risk stratify patients with COVID-19 infection. Cardiac MRI has detected and characterized myocardial injury, with changes compatible with other inflammatory cardiomyopathies. The long-term consequences of these inflammatory changes are unknown, but accumulating data will provide insight regarding the longitudinal impact of COVID-19 infection on cardiovascular morbidity and mortality.
新型冠状病毒肺炎（COVID-19）在全球范围内给卫生和经济带来了巨大的负担。患有心血管疾病的患者因 COVID-19 而更有可能出现严重疾病，并且发生并发症和死亡的风险更高。我们进行了叙述性文献综述，以评估 COVID-19 对心血管发病率和死亡率的影响。据报道，因 COVID-19 住院的患者中有 20%-30%存在心肌损伤，与预后较差和高死亡率（~50%-60%）相关。心肌损伤的潜在机制包括心肌内炎症（由于直接病毒感染或细胞因子风暴）、血管内皮炎、冠状动脉血管炎、心肌炎、缺血需求、斑块不稳定和右心室衰竭。鉴于 COVID-19 感染患者存在低氧性肺血管收缩、肺微血栓或肺栓塞，右心室特别容易受到损伤和衰竭的影响。超声心动图是评估左、右心室功能和对 COVID-19 感染患者进行风险分层的有效且易于获得的工具。心脏磁共振（cardiac MRI）已检测到并特征化了心肌损伤，这些改变与其他炎症性心肌病相符合。这些炎症变化的长期后果尚不清楚，但不断积累的数据将为了解 COVID-19 感染对心血管发病率和死亡率的长期影响提供依据。
