Infecţia COVID-19 şi sistemul cardiovascular: conexiunea indisolubilă cu consecinţe pregnante

Abstract

Rezumat Introducere. COVID-19 este cauzat de un nou betacoronavirus numit oficial de OMS drept SARS-CoV-2. Coronavirusurile sunt virusuri cu acid ribonucleic cu o singură catenă (ARN), cu proiecţii de suprafaţă, care corespund proteinelor spike de suprafaţă. Virusul SARS-CoV-2, care provoacă infecţia COVID-19, a atins niveluri de pandemie în luna martie 2020. În absenţa vaccinurilor sau a tratamentului medical curativ, COVID-19 manifestă un impact global fără precedent asupra sănătăţii publice şi a serviciilor medicale. SARSCoV- 2 nu provoacă doar pneumonie virală, dar are implicaţii majore asupra sistemului cardiovascular. Material şi metode. A fost studiată literatura ştiinţifică referitoare la infecţia cu noul virus SARS-CoV-2, care provoacă infecţia COVID-19, şi implicaţiile cardiovasculare ale acestuia. Materialul a fost sintetizat în baza articolelor internaţionale, în limba engleză – studii randomizate, de cohortă, cazuri clinice, publicate pe parcursul ultimului an şi câteva articole mai vechi publicate in ultimii 3 ani. Articolele au fost selectate din bazele de date PubMed şi Springer Link după cuvintele cheie: „SARS-CoV-2”, „COVID-19”, „cardiovascular system”, „cardiac disease”, „myocarditits”, „arrhythmia”, „hypertension”, „acute coronary syndrome”, „chronic cardiac damage”. Informaţia este prezentată sub formă de sinteză narativă. Rezultate. Pacienţii cu factori de risc cardiovasculari, precum şi pacienţii cu boli cardiovasculare stabilite şi boli cerebrovasculare au fost identificaţi ca fiind populaţii deosebit de vulnerabile, cu morbiditate şi mortalitate crescută atunci când suferă de COVID-19. O proporţie considerabilă a pacienţilor pot dezvolta leziuni cardiace în contextul COVID-19, care oferă un risc crescut de mortalitate intraspitalicească. Pe lângă complicaţiile trombotice arteriale şi venoase, ce se prezintă ca sindroame coronariene acute (SCA) şi tromboembolisme venoase (TEV), miocardita joacă un rol important în dezvoltarea insuficienţei cardiace (IC) acute. De asemenea, a fost raportată o gamă largă de aritmii care complică evoluţia COVID-19, incluzând potenţialele efecte pro-aritmice ale tratamentului COVID-19 şi patologiile asociate. Concluzii. Sindromul respirator acut sever coronavirus 2 (SARS-CoV-2), care provoacă boala coronavirus 2019 (COVID- 19), a atins niveluri de pandemie. Pacienţii cu factori de risc cardiovasculari şi boli cardiovasculare stabilite, reprezintă o populaţie vulnerabilă atunci când suferă de COVID-19, prezentând un risc crescut de morbiditate şi mortalitate.

Introduction. COVID-19 is caused by a new beta-coronavirus, officially named by the WHO as SARS-CoV-2. Coronaviruses are single-stranded ribonucleic acid (RNA) viruses with surface projections that correspond to surface spike proteins. The SARS-CoV-2 virus that causes COVID-19 infection reached pandemic levels in March 2020. In the absence of vaccines or curative medical treatment, COVID-19 has an unprecedented global impact on public health and health services. SARS-CoV-2 not only causes viral pneumonia, but also has major implications for the cardiovascular system. Material and methods. The scientific publications concerning the new SARS-CoV-2 virus, that causes the COVID-19 infection and its cardiovascular implications, has been studied. The material was synthesized based on international articles, in English – implying randomized trials, cohort studies, clinical cases, published during the last year and some older articles published in the last 3 years. The articles were selected from the PubMed and Springer Link databases by keywords: “SARS-CoV-2”, “COVID-19”, “cardiovascular system”, “cardiac disease”, “myocarditis”, “arrhythmia”, “hypertension”, “acute coronary syndrome”, “chronic cardiac injury”. The information is presented in the form of a narrative review. Results. Patients with cardiovascular risk factors, as well as the patients with established cardiovascular disease and cerebrovascular disease, have been identified as particularly vulnerable populations, with increased morbidity and mortality when suffering from COVID-19. A considerable proportion of patients may develop heart damage in the context of COVID-19, which provides an increased risk of in-hospital mortality. In addition to arterial and venous thrombotic complications, which present as acute coronary syndromes (ACS) and venous thromboembolisms (VTE), myocarditis plays an important role in the development of acute heart failure (HF). A wide range of arrhythmias, which complicates the evolution of COVID-19, has also been reported, including the potential pro-arrhythmic effects of COVID-19 treatment and associated pathologies. Conclusions. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19), has reached pandemic levels. Patients with established cardiovascular risk factors and cardiovascular disease are a vulnerable population when suffering from COVID-19, with an increased risk of morbidity and mortality.