Timpau Amalia-Stefana, Miftode Radu-Stefan, Leca Daniela, Timpau Razvan, Miftode Ionela-Larisa, Petris Antoniu Octavian, Costache Irina Iuliana, Mitu Ovidiu, Nicolae Ana, Oancea Alexandru, Jigoranu Alexandru, Tuchilus Cristina Gabriela, Miftode Egidia-Gabriela
Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania.
Department of Internal Medicine I (Cardiology), Faculty of Medicine, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania.
Life (Basel). 2022 Jul 20;12(7):1085. doi: 10.3390/life12071085.
The intricate relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the cardiovascular system is an extensively studied pandemic topic, as there is an ever-increasing amount of evidence that reports a high prevalence of acute cardiac injury in the context of viral infection. In patients with Coronavirus disease 2019, COVID-19, a significant increase in serum levels of cardiac troponin or other various biomarkers was observed, suggesting acute cardiac injury, thus predicting both a severe course of the disease and a poor outcome. Pathogenesis of acute cardiac injury is not yet completely elucidated, though several mechanisms are allegedly involved, such as a direct cardiomyocyte injury, oxygen supply-demand inequity caused by hypoxia, several active myocardial depressant factors during sepsis, and endothelial dysfunction due to the hyperinflammatory status. Moreover, the increased levels of plasma cytokines and catecholamines and a significantly enhanced prothrombotic environment may lead to the destabilization and rupture of atheroma plaques, subsequently triggering an acute coronary syndrome. In the present review, we focus on describing the epidemiology, pathogenesis, and role of biomarkers in the diagnosis and prognosis of patients with acute cardiac injury in the setting of the COVID-19 pandemic. We also explore some novel therapeutic strategies involving immunomodulatory therapy, as well as their role in preventing a severe form of the disease, with both the short-term outcome and the long-term cardiovascular sequelae being equally important in patients with SARS-CoV-2 induced acute cardiac injury.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）与心血管系统之间的复杂关系是一个被广泛研究的大流行话题，因为越来越多的证据表明，在病毒感染的情况下，急性心脏损伤的患病率很高。在2019冠状病毒病（COVID-19）患者中，观察到血清心肌肌钙蛋白或其他各种生物标志物水平显著升高，提示存在急性心脏损伤，从而预示疾病的严重病程和不良预后。急性心脏损伤的发病机制尚未完全阐明，尽管据称涉及多种机制，如直接心肌细胞损伤、缺氧导致的氧供需不平衡、脓毒症期间的几种活性心肌抑制因子以及高炎症状态引起的内皮功能障碍。此外，血浆细胞因子和儿茶酚胺水平的升高以及显著增强的促血栓形成环境可能导致动脉粥样硬化斑块的不稳定和破裂，随后引发急性冠状动脉综合征。在本综述中，我们重点描述了在COVID-19大流行背景下急性心脏损伤患者的流行病学、发病机制以及生物标志物在诊断和预后中的作用。我们还探讨了一些涉及免疫调节治疗的新型治疗策略，以及它们在预防严重疾病形式中的作用，对于SARS-CoV-2诱导的急性心脏损伤患者，短期结局和长期心血管后遗症同样重要。
