Peer-reviewed general biomedical journal
Clinical Reviews
Medwave 2020;20(7):e8008 doi: 10.5867/medwave.2020.07.8008
Cardiovascular implications of SARS-CoV-2 infection: A literature review
Mario B García-Saavedra, Renzo R Rosales-Gutiérrez, Esmeralda Valverde, Maryuri Chumbes-Aguirre, Ricardo Alvarado, Robert Polo, Rubén Azañero, Carlos Chávez
Key Words: coronavirus, cardiovascular diseases, coronavirus infections
Abstract
In December 2019, a new strain of the SARS-CoV-2 coronavirus was reported in Wuhan, China, which produced severe lung involvement and progressed to respiratory distress. To date, more than seventeen million confirmed cases and more than half a million died worldwide from COVID-19. Patients with cardiovascular disease are more susceptible to contracting this disease and presenting more complications. We did a literature search on the association of cardiovascular disease and COVID-19 in databases such as Scopus, PubMed/MEDLINE, and the Cochrane Library. The purpose of this review is to provide updated information for health professionals who care for patients with COVID-19 and cardiovascular disease, given that they have a high risk of complications and mortality. Treatment with angiotensin-converting enzyme inhibitors and receptor blockers is controversial, and there is no evidence not to use these medications in patients with COVID-19. Regarding treatment with hydroxychloroquine associated or not with azithromycin, there is evidence of a higher risk with its use than clinical benefit and decreased mortality. Likewise, patients with heart failure are an important risk group due to their condition per se. Patients with heart failure and COVID-19 are a diagnostic dilemma because the signs of acute heart failure could be masked. On the other hand, in patients with acute coronary syndrome, the initial therapeutic approach could change in the context of the pandemic, although only based on expert opinions. Nonetheless, many controversial issues will be the subject of future research.
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En diciembre de 2019 se reportó en Wuhan, China, la aparición de una nueva cepa de coronavirus SARS-CoV-2 que producía un compromiso pulmonar severo y progresaba a estrés respiratorio agudo. A la fecha, son más de diecisiete millones los casos confirmados y más de medio millón los fallecidos en todo el mundo a causa de COVID-19. Los estudios reportan que los pacientes con enfermedad cardiovascular son más susceptibles a contraer esta enfermedad y a presentar más complicaciones. El propósito de esta revisión es proporcionar información actualizada para los profesionales de la salud que atienden a pacientes con COVID-19 y que tienen además enfermedad cardiovascular y por ende un riesgo elevado de complicaciones y mortalidad. Realizamos una búsqueda de bibliografía científica acerca de la asociación de enfermedad cardiovascular y COVID-19 en diferentes bases de datos como Scopus, MEDLINE vía PubMed y Cochrane Library. El tratamiento con inhibidores de la enzima convertidora de angiotensina y bloqueadores del receptor de angiotensina ha sido motivo de discusión y no hay evidencia sólida para contraindicarlo en pacientes con COVID-19. Respecto al tratamiento con hidroxicloroquina asociado o no con azitromicina, hay evidencia que demuestra un mayor riesgo con su utilización, que beneficio clínico y/o disminución de mortalidad. En este contexto, los pacientes con insuficiencia cardíaca representan un grupo importante de riesgo por su condición per se y por el dilema diagnóstico generado al evaluar un paciente con COVID-19, en el que los signos de insuficiencia cardíaca aguda podrían enmascararse. Por otro lado, en los pacientes con síndrome coronario agudo, el enfoque terapéutico inicial podría cambiar en el contexto de la pandemia, aunque sólo sobre la base de opiniones de expertos. Quedan, sin embargo, muchos temas en controversia que serán motivo de investigaciones futuras.
Authors:
Mario B García-Saavedra[1], Renzo R Rosales-Gutiérrez[2], Esmeralda Valverde[1], Maryuri Chumbes-Aguirre[2], Ricardo Alvarado[2], Robert Polo[2], Rubén Azañero[2], Carlos Chávez[1]
Affiliation:
[1] Servicio de Cardiología, Hospital Nacional Daniel Alcides Carrión, Callao, Perú
[2] Servicio de Cardiología, Hospital Nacional Dos de Mayo, Lima, Perú
E-mail: mariob.garsa@gmail.com
Author address:
[1] Jirón Iquique 645, Breña Lima, Perú Código postal: 15082
Citation: García-Saavedra MB, Rosales-Gutiérrez RR, Valverde E, Chumbes-Aguirre M, Alvarado R, Polo R, et al. Cardiovascular implications of SARS-CoV-2 infection: A literature review. Medwave 2020;20(7):e8008 doi: 10.5867/medwave.2020.07.8008
Submission date: 17/5/2020
Acceptance date: 3/8/2020
Publication date: 28/8/2020
Origin: Not commissioned
Type of review: Externally peer-reviewed by three reviewers, double-blind
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- Ky B, Mann DL. COVID-19 Clinical Trials: A Primer for the Cardiovascular and Cardio-Oncology Communities. JACC CardioOncol. 2020 Apr 17;2(2):254–69. | CrossRef | PubMed |
- Giudicessi JR, Noseworthy PA, Friedman PA, Ackerman MJ. Urgent Guidance for Navigating and Circumventing the QTc-Prolonging and Torsadogenic Potential of Possible Pharmacotherapies for Coronavirus Disease 19 (COVID-19). Mayo Clin Proc. 2020 Jun;95(6):1213-1221. | CrossRef | PubMed |
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- Vandenberk B, Vandael E, Robyns T, Vandenberghe J, Garweg C, Foulon V, et al. Which QT Correction Formulae to Use for QT Monitoring? J Am Heart Assoc. 2016 Jun 17;5(6):e003264. | CrossRef | PubMed |
- Tang W, Cao Z, Han M, Wang Z, Chen J, Sun W, et al. Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial. BMJ. 2020 May 14;369:m1849. | CrossRef | PubMed |
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Brueck H, Gal S. How the coronavirus death toll compares to other pandemics, including SARS, HIV, and the Black Death. Business Insider. 2020. [On line]. | Link |Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395(10223):497-506. | CrossRef | PubMed |Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020 Apr 22;323(20):2052–9. | CrossRef | PubMed |World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID 19). WHO; 2020. [On line]. | Link |Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020 Mar 27;5(7):1–8. | CrossRef | PubMed |Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol. 2020 May;17(5):259-260. | CrossRef | PubMed |Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020 Feb 15;395(10223):514-523. | CrossRef | PubMed |Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020 Mar 13;180(7):1–11. | CrossRef | PubMed |Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395(10229):1054-1062. | CrossRef | PubMed |Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020 Feb 7;323(11):1061–9. | CrossRef | PubMed |Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020 Apr 16;181(2):271-280.e8. | CrossRef | PubMed |Danser AHJ, Epstein M, Batlle D. Renin-Angiotensin System Blockers and the COVID-19 Pandemic: At Present There Is No Evidence to Abandon Renin-Angiotensin System Blockers. Hypertension. 2020 Jun;75(6):1382-1385. | CrossRef | PubMed |Patel AB, Verma A. COVID-19 and Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers: What Is the Evidence? JAMA. 2020 Mar 24. | CrossRef | PubMed |Bozkurt B, Kovacs R, Harrington B. HFSA/ACC/AHA Statement Addresses Concerns Re: Using RAAS Antagonists in COVID-19. ACC News Story. 2020. [On line]. | Link |Rice GI, Thomas DA, Grant PJ, Turner AJ, Hooper NM. Evaluation of angiotensin-converting enzyme (ACE), its homologue ACE2 and neprilysin in angiotensin peptide metabolism. Biochem J. 2004 Oct 1;383(Pt 1):45-51. | CrossRef | PubMed |Rosenberg ES, Dufort EM, Udo T, Wilberschied LA, Kumar J, Tesoriero J, et al. Association of Treatment With Hydroxychloroquine or Azithromycin With In-Hospital Mortality in Patients With COVID-19 in New York State. JAMA. 2020 May 11;323(24):2493–502. | CrossRef | PubMed |Geleris J, Sun Y, Platt J, Zucker J, Baldwin M, Hripcsak G, et al. Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19. N Engl J Med. 2020 Jun 18;382(25):2411-2418. | CrossRef | PubMed |Homolak J, Kodvanj I. Widely available lysosome targeting agents should be considered as potential therapy for COVID-19. Int J Antimicrob Agents. 2020 Aug;56(2):106044. | CrossRef | PubMed |Sinha N, Balayla G. Hydroxychloroquine and covid-19. Postgrad Med J. 2020 Apr 15:postgradmedj-2020-137785. | CrossRef | PubMed |Dixon DL, Van Tassell BW, Vecchié A, Bonaventura A, Talasaz AH, Kakavand H, et al. Cardiovascular Considerations in Treating Patients With Coronavirus Disease 2019 (COVID-19). J Cardiovasc Pharmacol. 2020 May;75(5):359-367. | CrossRef | PubMed |Cramer CL, Patterson A, Alchakaki A, Soubani AO. Immunomodulatory indications of azithromycin in respiratory disease: a concise review for the clinician. Postgrad Med. 2017 Jun;129(5):493-499. | CrossRef | PubMed |Roden DM, Harrington RA, Poppas A, Russo AM. Considerations for Drug Interactions on QTc in Exploratory COVID-19 Treatment. Circulation. 2020 Jun 16;141(24):e906-e907. | CrossRef | PubMed |Simpson TF, Kovacs RJ, Stecker E. Ventricular Arrhythmia Risk Due to Hydroxychloroquine-Azithromycin Treatment For COVID 19. Cardiology Magazine. 2020. [On line]. | Link |Ky B, Mann DL. COVID-19 Clinical Trials: A Primer for the Cardiovascular and Cardio-Oncology Communities. JACC CardioOncol. 2020 Apr 17;2(2):254–69. | CrossRef | PubMed |Giudicessi JR, Noseworthy PA, Friedman PA, Ackerman MJ. Urgent Guidance for Navigating and Circumventing the QTc-Prolonging and Torsadogenic Potential of Possible Pharmacotherapies for Coronavirus Disease 19 (COVID-19). Mayo Clin Proc. 2020 Jun;95(6):1213-1221. | CrossRef | PubMed |Tisdale JE, Jaynes HA, Kingery JR, Mourad NA, Trujillo TN, Overholser BR, et al. Development and validation of a risk score to predict QT interval prolongation in hospitalized patients. Circ Cardiovasc Qual Outcomes. 2013 Jul;6(4):479-87. | CrossRef | PubMed |Tisdale JE. Drug-induced QT interval prolongation and torsades de pointes: Role of the pharmacist in risk assessment, prevention and management. Can Pharm J (Ott). 2016 May;149(3):139-52. | CrossRef | PubMed |The European Society of Cardiology. Guidance for the Diagnosis and Management of CV Disease during the COVID 19 Pandemic. ESC; 2020. [On line]. | Link |Kapoor A, Pandurangi U, Arora V, Gupta A, Jaswal A, Nabar A, et al. Cardiovascular risks of hydroxychloroquine in treatment and prophylaxis of COVID-19 patients: A scientific statement from the Indian Heart Rhythm Society. Indian Pacing Electrophysiol J. 2020 May-Jun;20(3):117-120. | CrossRef | PubMed |Vandenberk B, Vandael E, Robyns T, Vandenberghe J, Garweg C, Foulon V, et al. Which QT Correction Formulae to Use for QT Monitoring? J Am Heart Assoc. 2016 Jun 17;5(6):e003264. | CrossRef | PubMed |Tang W, Cao Z, Han M, Wang Z, Chen J, Sun W, et al. Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial. BMJ. 2020 May 14;369:m1849. | CrossRef | PubMed |Mahévas M, Tran VT, Roumier M, Chabrol A, Paule R, Guillaud C, et al. Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data. BMJ. 2020 May 14;369:m1844. | CrossRef | PubMed |Randomised Evaluation of COVID-19 therapy. No clinical benefit from use of hydroxychloroquine in hospitalised patients with COVID-19.RECOVERY Trial; 2020. [On line]. | Link |Boulware DR, Pullen MF, Bangdiwala AS, Pastick KA, Lofgren SM, Okafor EC, et al. A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19. N Engl J Med. 2020 Aug 6;383(6):517-525. | CrossRef | PubMed |World Health Organization. Solidarity clinical trial for COVID-19 treatments. WHO; 2020. [On line]. | Link |Dong N, Cai J, Zhou Y, Liu J, Li F. End-Stage Heart Failure With COVID-19: Strong Evidence of Myocardial Injury by 2019-nCoV. JACC Heart Fail. 2020 Jun;8(6):515-517. | CrossRef | PubMed |Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med. 2020 Apr;8(4):e21. | CrossRef | PubMed |Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med. 2020 Apr;46(4):586-590. | CrossRef | PubMed |Torres A, Rivera A, García A, Arias CA, Saldarriaga CI, Gómez EA, et al. Evaluación y tratamiento de la insuficiencia cardíaca durante la pandemia de COVID 19: resumen ejecutivo. Rev Colomb Cardiol. 2020. [On line]. | Link |Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020 Feb 15;395(10223):507-513. | CrossRef | PubMed |Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016 Jul 14;37(27):2129-2200. | CrossRef | PubMed |Felker GM, Ellison DH, Mullens W, Cox ZL, Testani JM. Diuretic Therapy for Patients With Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020 Mar 17;75(10):1178-1195. | CrossRef | PubMed |Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Apr 30;382(18):1708-1720. | CrossRef | PubMed |Mahmud E, Dauerman HL, Welt FGP, Messenger JC, Rao SV, Grines C, et al. Management of acute myocardial infarction during the COVID-19 pandemic: A Consensus Statement from the Society for Cardiovascular Angiography and Interventions (SCAI), the American College of Cardiology (ACC), and the American College of Emergency Physicians (ACEP). Catheter Cardiovasc Interv. 2020 Aug;96(2):336-345. | CrossRef | PubMed |Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential Effects of Coronaviruses on the Cardiovascular System: A Review. JAMA Cardiol. 2020 Mar 27. | CrossRef | PubMed |Cosentino N, Assanelli E, Merlino L, Mazza M, Bartorelli AL, Marenzi G. An In-hospital Pathway for Acute Coronary Syndrome Patients During the COVID-19 Outbreak: Initial Experience Under Real-World Suboptimal Conditions. Can J Cardiol. 2020 Jun;36(6):961-964. | CrossRef | PubMed |Tam CF, Cheung KS, Lam S, Wong A, Yung A, Sze M, et al. Impact of Coronavirus Disease 2019 (COVID-19) Outbreak on ST-Segment-Elevation Myocardial Infarction Care in Hong Kong, China. Circ Cardiovasc Qual Outcomes. 2020 Apr;13(4):e006631. | CrossRef | PubMed |
July 2022, Vol 22, Issue 6
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