scholarly journals Mechanism of Blood–Heart-Barrier Leakage: Implications for COVID-19 Induced Cardiovascular Injury

2021 ◽  
Vol 22 (24) ◽  
pp. 13546
Author(s):  
Rubens P. Homme ◽  
Akash K. George ◽  
Mahavir Singh ◽  
Irina Smolenkova ◽  
Yuting Zheng ◽  
...  
Keyword(s):  
Heart Failure ◽  
Human Subjects ◽  
Viral Myocarditis ◽  
Vena Cava ◽  
The Novel ◽  
Barrier Dysfunction ◽  
Novel Coronavirus ◽  
Cardiac Manifestations ◽  
Endocardial Endothelium ◽  
Metalloproteinase 9

Although blood–heart-barrier (BHB) leakage is the hallmark of congestive (cardio-pulmonary) heart failure (CHF), the primary cause of death in elderly, and during viral myocarditis resulting from the novel coronavirus variants such as the severe acute respiratory syndrome novel corona virus 2 (SARS-CoV-2) known as COVID-19, the mechanism is unclear. The goal of this project is to determine the mechanism of the BHB in CHF. Endocardial endothelium (EE) is the BHB against leakage of blood from endocardium to the interstitium; however, this BHB is broken during CHF. Previous studies from our laboratory, and others have shown a robust activation of matrix metalloproteinase-9 (MMP-9) during CHF. MMP-9 degrades the connexins leading to EE dysfunction. We demonstrated juxtacrine coupling of EE with myocyte and mitochondria (Mito) but how it works still remains at large. To test whether activation of MMP-9 causes EE barrier dysfunction, we hypothesized that if that were the case then treatment with hydroxychloroquine (HCQ) could, in fact, inhibit MMP-9, and thus preserve the EE barrier/juxtacrine signaling, and synchronous endothelial-myocyte coupling. To determine this, CHF was created by aorta-vena cava fistula (AVF) employing the mouse as a model system. The sham, and AVF mice were treated with HCQ. Cardiac hypertrophy, tissue remodeling-induced mitochondrial-myocyte, and endothelial-myocyte contractions were measured. Microvascular leakage was measured using FITC-albumin conjugate. The cardiac function was measured by echocardiography (Echo). Results suggest that MMP-9 activation, endocardial endothelial leakage, endothelial-myocyte (E-M) uncoupling, dyssynchronous mitochondrial fusion-fission (Mfn2/Drp1 ratio), and mito-myocyte uncoupling in the AVF heart failure were found to be rampant; however, treatment with HCQ successfully mitigated some of the deleterious cardiac alterations during CHF. The findings have direct relevance to the gamut of cardiac manifestations, and the resultant phenotypes arising from the ongoing complications of COVID-19 in human subjects.

scholarly journals Cardiac Echocardiography in COVID-19 Infection

2020 ◽  
Vol 04 (01) ◽  
pp. 56-60
Author(s):  
Rohan Kapur ◽  
Naveen Garg ◽  
K. K. Kapur ◽  
Pranav Kapoor ◽  
Poonam Malhotra Kapoor
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Involvement ◽  
Troponin I ◽  
Service Providers ◽  
The Novel ◽  
Cardiac Enzymes ◽  
Cardiac Evaluation ◽  
Novel Coronavirus ◽  
Cardiac Manifestations ◽  
Current Guidelines

AbstractThe novel COVID-19 disease mainly affects respiratory organs; however, involvement of cardiovascular system is also not uncommon. Cardiac involvement can manifest as myocarditis, heart failure, myocardial infarction, pulmonary embolism, or arrhythmias in COVID-19 patients. This novel Coronavirus enters into the cells of the human body by binding to ACE-2 receptors which are predominantly present on pneumocytes and cardiomyocytes. The damage to myocardium is manifested by the increase in cardiac enzymes such as troponin-I, CK-MB, and NT pro-BNP. Although echocardiogram is an important tool in the cardiac evaluation of COVID-19 patients, its indiscriminate use is discouraged, owing to the risk of transmission to echocardiography service providers, as well as possible risk of contaminating echocardiography equipment. In this article, we discuss the different mechanisms and cardiac manifestations of COVID-19. We also review the current guidelines for echocardiography evaluation of COVID-19 patients as well as current recommendations on safety of echocardiography personnel and equipment against contamination. We also include our experience of two cases in which COVID-19 affliction of heart was strongly suspected, and echocardiography clinched the diagnosis.

scholarly journals Living with heart failure during the COVID-19 pandemic: an interpretative phenomenological analysis

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
AM Trenta ◽  
D Ausili ◽  
R Caruso ◽  
M Moro ◽  
T Nania ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coping Strategies ◽  
Interpretative Phenomenological Analysis ◽  
Healthcare Systems ◽  
Phenomenological Analysis ◽  
The Novel ◽  
Targeted Interventions ◽  
Heart Failure Patients ◽  
Patients With Heart Failure ◽  
Novel Coronavirus

Abstract Funding Acknowledgements Type of funding sources: None. Background The COVID-19 outbreak has presented significant challenges for healthcare systems worldwide, which are responsible for guaranteeing access to care for all patients and limiting the spread of the virus. The necessary changes in the healthcare systems have deeply impacted not only people affected by the novel coronavirus, but also those with chronic conditions, such as heart failure. Since the beginning of the pandemic, a reduction of routine visits and use of emergency services by patients with heart failure has been observed, and these patients have tended to visit the hospital only when their symptoms were severe. The consequences of the COVID-19 pandemic on heart failure patients’ lives have not yet been investigated. Purpose To explore the lived experiences of patients with heart failure during the COVID-19 pandemic. Methods A qualitative investigation based on interpretative phenomenological analysis was conducted. Fourteen patients with heart failure (12 males and 2 females with a median age of 68 years) completed in-depth, semi-structured interviews. Triangulation, journaling and member checking were used to improve the rigour of the study. Results Three themes describing the lived experience of patients were identified: "being vulnerable", "hanging in the balance", and "coping strategies". Patients reported feeling particularly vulnerable to the novel coronavirus due to their clinical conditions, and therefore they experienced fear and anxiety. Changes in the healthcare systems due to the COVID-19 pandemic created a sense of uncertainty that patients described as a feeling of hanging in the balance. However, despite these relevant difficulties, heart failure patients have managed to deal with the situation using various coping strategies, such as acceptance, recreational activities, family reorganization, and use of technology. Conclusions The COVID-19 outbreak deeply affected the lives of patients with heart failure, and our results highlight the relevant difficulties they have faced. We point out that there is a great need for targeted interventions, and these could be developed taking into consideration the coping strategies described in the study.

scholarly journals Cardiorespiratory complications in pediatric oncology patients with COVID-19 infection

2021 ◽  
Author(s):  
Peter Schoettler ◽  
Paul Sue ◽  
Tamra Slone ◽  
Andrew Koh
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Respiratory Failure ◽  
Cancer Therapy ◽  
Cardiac Function ◽  
Pediatric Oncology ◽  
The Novel ◽  
Oncology Patients ◽  
Novel Coronavirus ◽  
Active Cancer

The risk of the novel coronavirus disease 2019 (COVID-19) to pediatric oncology patients is unknown. Here, we report eight pediatric oncology patients receiving active cancer therapy that tested positive for COVID-19. Three developed severe cardiorespiratory symptoms (as defined by evidence of heart failure by echocardiogram and/or intubation secondary to respiratory failure), including one death as a result of COVID-19 infection. We identified prior anthracycline exposure and pre-COVID cardiac function as significantly associated with the development of severe cardiorespiratory complications. These data merit future and further investigation of risk factors for severe complications related to COVID-19 infections in pediatric oncology patients.

scholarly journals Research Progress on the Cardiac Injury from ACE2 Targeting in SARS-CoV-2 Infection

Biomolecules ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 196
Author(s):  
Hao Sun ◽  
Xiaojuan Su ◽  
Lingyi Huang ◽  
Dezhi Mu ◽  
Yi Qu
Keyword(s):  
Structural Characteristics ◽  
Antiviral Agents ◽  
Cardiac Injury ◽  
Research Progress ◽  
The Novel ◽  
Angiotensin Converting Enzyme 2 ◽  
Target Organs ◽  
Therapeutic Measures ◽  
Novel Coronavirus ◽  
Cardiac Manifestations

The epidemic due to the novel coronavirus (SARS-CoV-2) is now a global concern, posing a severe threat to the health of populations. At present, all countries in the world are stepping up the development of vaccines and antiviral agents to prevent the infection and further transmission of SARS-CoV-2. An in-depth investigation of the target organs and pathogenesis regarding SARS-CoV-2 infection will be beneficial for virus therapy. Besides pulmonary injury, SARS-CoV-2 also causes cardiac injury, but the exact mechanisms are unclear. This review summarizes the essential structural characteristics of SARS-CoV-2 and angiotensin-converting enzyme 2 (ACE2), describes the cardiac manifestations following SARS-CoV-2 infection, and explores the mechanisms of cardiac injury targeting ACE2 after the viral invasion. We aim to help the timely detection of related symptoms and implementation of therapeutic measures by clinicians for SARS-CoV-2 infection.

scholarly journals The Characteristics, Manifestations and Cardiopulmonary Imaging (CT/MRI) of COVID-19 in SARS-CoV-2 Infection

2021 ◽  
Vol 6 (2) ◽  
pp. 48-52
Author(s):  
Abigaela Rus ◽  
Nora Rat ◽  
Monica Chitu ◽  
Imre Benedek
Keyword(s):  
Cardiovascular Complications ◽  
Public Health Emergency ◽  
World Health ◽  
Imaging Features ◽  
The Novel ◽  
The World ◽  
Novel Coronavirus ◽  
Health Organization ◽  
Cardiac Manifestations ◽  
Expert Recommendations

Abstract The World Health Organization (WHO) declared the transmission of SARS-CoV-2 a Public Health Emergency of International Concern. The novel coronavirus has diverse manifestations, usually similar to a common cold or influenza. The majority of patients with coronavirus disease have typical imaging features. The typical CT characteristics of patients with COVID-19 pneumonia are ground-glass opacities and consolidative lesions with a peripheral and posterior distribution. Noninvasive imaging methods are precise and rapid means of diagnosing pneumonia and cardiovascular complications caused by COVID-19 infection. Therefore, it is important for clinicians to understand the implications of this pandemic and to be familiar with the different imaging aspects of the novel coronavirus disease. This review focuses on the most commonly reported imaging findings of COVID-19 infection in different patients from different countries, the expert recommendations, and the cardiac manifestations of SARS-CoV-2 infection.

scholarly journals Left Ventricular Assist Device Implantation to a Child with End Stage Heart Failure In The Novel Coronavirus Pandemic Period

2020 ◽  
Author(s):  
Tanıl Özer ◽  
Deniz Günay ◽  
Mehmet Aksüt ◽  
Özge Altaş ◽  
Emre Gürcü ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Assist Device ◽  
Left Ventricular ◽  
The Novel ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist ◽  
End Stage Heart Failure ◽  
Novel Coronavirus ◽  
End Stage

Abstract At the end of the 2019, a novel coronavirus disease (COVID-19) appeared in Wuhan, China and spread rapidly to all over the world. Then, the attentions of almost all health care providers have shifted to this health emergency situation which is identified as pandemic. The novel coronavirus pandemic has impacted the physicians at the all field of medicine not to perform their routine treatment practice. Since it is not clear when this situation will end, there is still debate about how to manage the treatment strategies for the patients who have end stage heart failure such another life threatening illness. The aim of this case presentation is to create a consideration about timing of left ventricular assist device implantations during novel coronavirus pandemic period.

scholarly journals Miocarditis in Patients with COVID-19 Confirmed by Immunohistochemical

Kardiologiia ◽  
2020 ◽  
Vol 60 (7) ◽  
pp. 4-10 ◽  
Author(s):  
E. A. Kogan ◽  
Yu. S. Berezovskiy ◽  
O. V. Blagova ◽  
A. D. Kukleva ◽  
G. A. Bogacheva ◽  
...  
Keyword(s):  
Histological Study ◽  
Viral Myocarditis ◽  
Polymerase Chain Reaction Test ◽  
The Novel ◽  
Morphological Examination ◽  
Positive Polymerase Chain Reaction ◽  
Lymphocytic Myocarditis ◽  
Coronavirus Infection ◽  
Novel Coronavirus ◽  
Chain Reaction Test

Aim      Despite the regular heart damage in patients with coronavirus pneumonia caused by SARS-Cov-2, a possibility of developing lymphocytic myocarditis as a part of COVID-19 remains unsubstantiated. The aim of this study was to demonstrate a possibility of lymphocytic myocarditis and to study its morphological features in patients with the novel coronavirus infection (COVID-19) with a severe course.Material and methods   Postmortem data were studied for 5 elderly patients (74.8±4.4 years; 3 men and 2 women) with the novel coronavirus infection and bilateral, severe polysegmental pneumonia (stage 3–4 by computed tomography). COVID-19 was diagnosed based on the typical clinical presentation and positive polymerase chain reaction test in nasopharyngeal swabs. All patients were treated in different hospitals repurposed for the treatment of patients with COVID-19. A standard histological study was performed with hematoxylin and eosin, toluidine blue, and van Gieson staining. Serial paraffin slices were studied immunohistochemically with antibodies to CD3, СD68, CD20, perforin, and toll-like receptors (TLR) 4 and 9.Results In none of the cases, myocarditis was suspected clinically, added to the diagnosis or indicated as a possible cause of death. IHD and acute myocardial infarction were mentioned as error diagnoses not confirmed by the postmortem examination. The morphological examination of the heart identified signs of lymphocytic myocarditis consistent with Dallas criteria for this diagnosis. Myocardial infiltrate was characterized in detail, and a combined inflammatory damage of endocardium and pericardium was described. The immunohistochemical study with cell infiltrate typing confirmed the presence of CD3-positive Т lymphocytes and the increased expression of TLR-4. A picture of coronaritis, including that with microvascular thrombosis, was found in all cases.Conclusion      A possibility for development of lymphocytic viral myocarditis in COVID-19 was confirmed morphologically and immunohistochemically. Specific features of myocarditis in COVID-19 include the presence of coronaritis and a possible combination of myocarditis with lymphocytic endo- and pericarditis.

scholarly journals COVID-19 and risk of cardiomyocyte injury: The prevailing scenario

2021 ◽  
Vol 5 (01) ◽  
pp. 1-8
Author(s):  
Marwa S. Al-Niemi ◽  
Nawar R. Hussain ◽  
Hayder M. Al-Kuraishy ◽  
Ali I. Al-Gareeb
Keyword(s):  
Cardiac Electrophysiology ◽  
Cardiac Fibrosis ◽  
Contractile Function ◽  
Lung Damage ◽  
The Novel ◽  
Pulmonary Manifestations ◽  
Novel Coronavirus ◽  
Cardiac Status ◽  
Cardiac Manifestations ◽  
Putative Mechanism

The novel coronavirus which is also called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is responsible for COVID-19 (coronavirus disease 2019). SARS-CoV-2 is known to cause substantial pulmonary disease, including pneumonia and acute respiratory distress syndrome (ARDS), clinicians have observed many extra-pulmonary manifestations of COVID-19. SARS-CoV-2 infection is associated with a variety of pro-inflammatory mediators that may play important roles in the pathophysiology of cardiac and arrhythmic complications. Systemic inflammatory response syndrome (cytokine storm) is another putative mechanism of myocardial injury. In addition to lung damage, there may be significant cardiac involvement in patients with COVID-19, which is responsible for worsening the clinical condition of the host. The main cardiac manifestations can be oedema, pericarditis, cardiac fibrosis, myocarditis, impairment of contractile function and cardiac electrophysiology. The cardiac status of patients with ongoing SARS-CoV-2 infection of surviving patients in convalescence period should be carefully monitored.

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