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Preface| Volume 19, ISSUE 2, Pxi-xiii, April 2023

Cardiovascular Effects of COVID-19

DOI:https://doi.org/10.1016/j.hfc.2023.02.001
Cardiovascular Effects of COVID-19
Previous ArticleForthcoming Issues
Next ArticleThe Cardiovascular Manifestations of COVID-19
      Figure thumbnail fx1
      Timothy D. Henry, MD, FACC, MSCAI, Editor
      Figure thumbnail fx2
      Santiago Garcia, MD, FACC, FSCAI, Editor
      Figure thumbnail fx3
      Eduardo Bossone, MD, PhD, FCCP, FESC, FACC, Editor
      The COVID-19 pandemic has had a dramatic impact on the care of patients with cardiovascular disease throughout the world. COVID-19 has a myriad of direct effects on the myocardium, vasculature, and coagulation cascade, related to the proinflammatory and prothrombotic effects of the virus, leading to an increased risk of myocardial infarction, stroke, deep venous thrombosis, and pulmonary emboli within the first 2 to 4 weeks of contracting the disease (Fig. 1).
      • Madjid M.
      • Safavi-Naeini P.
      • Solomon S.D.
      • et al.
      Potential effects of coronaviruses on the cardiovascular system: a review.
      JAMA Cardiol. 2020; 5: 831-840
      , 
      • Gupta A.
      • Madhavan M.V.
      • Sehgal K.
      • et al.
      Extrapulmonary manifestations of COVID-19.
      Nat Med. 2020; 26: 1017-1032
      , 
      • Henry T.D.
      • Kereiakes D.J.
      The direct and indirect effects of the COVID-19 pandemic on cardiovascular disease throughout the world.
      Eur Heart J. 2022; 43: 1154-1156
      , 
      • Garcia S.
      • Dehghani P.
      • Grines C.
      • et al.
      Initial findings from the North American COVID-19 Myocardial Infarction Registry.
      J Am Coll Cardiol. 2021; 77: 1994-2003
      Figure thumbnail gr1
      Fig. 1The direct and indirect effects of COVID-19 on cardiovascular disease.
      (From Henry TD, Kereiakes DJ. The direct and indirect effects of the COVID-19 pandemic on cardiovascular disease throughout the world. Eur Heart J. 2022 Mar 14;43(11):1154-1156. https://doi.org/10.1093/eurheartj/ehab782. PMID: 34791131; PMCID: PMC8690059.)
      Patients with heart failure constitute a subgroup of patients at high risk of complications from COVID-19.
      • Bhatt A.S.
      • Jering K.S.
      • Vaduganathan M.
      • et al.
      Clinical outcomes in patients with heart failure hospitalized with COVID-19.
      JACC Heart Fail. 2021; 9: 65-73
      ,
      • Alvarez-Garcia J.
      • Lee S.
      • Gupta A.
      • et al.
      Prognostic impact of prior heart failure in patients hospitalized with COVID-19.
      J Am Coll Cardiol. 2020; 76: 2334-2348
      Preexisting heart failure is associated with increased mortality in patients hospitalized with COVID-19. Worsening functional heart failure class has been associated with increased duration of hospitalization and escalation of therapies leading to increased mortality.
      • Bhatt A.S.
      • Jering K.S.
      • Vaduganathan M.
      • et al.
      Clinical outcomes in patients with heart failure hospitalized with COVID-19.
      JACC Heart Fail. 2021; 9: 65-73
      ,
      • Alvarez-Garcia J.
      • Lee S.
      • Gupta A.
      • et al.
      Prognostic impact of prior heart failure in patients hospitalized with COVID-19.
      J Am Coll Cardiol. 2020; 76: 2334-2348
      Similarly, 3% to 25% of patients developed left-ventricular dysfunction after admission from COVID-19. The overall mortality for hospitalized heart failure patients with COVID-19 was between 4% and 40%. Possible mechanisms of COVID-19 and heart failure include effects of proinflammatory cytokine storm in patients with COVID-19 affecting the myocardium, direct myocardial injury, such as myocarditis, coronary thrombosis, late presentations of acute myocardial infarction, and acute respiratory failure leading to myocardial supply, demand mismatch leading to oxidative stress and damage to the cardiomyocytes. The role of mRNA vaccines, as potential triggers of myocarditis, is also an important consideration, particularly in young men.
      The indirect effects of the pandemic in terms of disruption of health care processes and pathways of care have been as dramatic.
      • Gupta A.
      • Madhavan M.V.
      • Sehgal K.
      • et al.
      Extrapulmonary manifestations of COVID-19.
      Nat Med. 2020; 26: 1017-1032
      ,
      • Gluckman T.J.
      • Bhave N.M.
      • et al.
      2022 ACC expert consensus decision pathway on cardiovascular sequelae of COVID-19 in adults: myocarditis and other myocardial involvement, post-acute sequelae of SARS-CoV-2 infection, and return to play: a report of the American College of Cardiology Solution Set Oversight Committee.
      J Am Coll Cardiol. 2022; 79: 1717-1756
      , 
      • Nadarajah R.
      • Wu J.
      • Hurdus B.
      • et al.
      The collateral damage of COVID-19 to cardiovascular services: a meta-analysis.
      Eur Heart J. 2022; 43: 3164-3178
      , 
      • Garcia S.
      • Albaghdadi M.S.
      • Meraj W.M.
      • et al.
      Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic.
      J Am Coll Cardiol. 2020; 75: 2871-2872
      Public health measures designed to mitigate the spread of the virus, such as lockdowns, cancellation or deferral of elective procedures, in person appointments, and restrictive visitation policies, resulted in patients’ reluctance to obtain both elective and emergent medical care. This resulted in a reduction in the number of patients with ST-segment elevation myocardial infarction (STEMI) presenting to hospitals throughout the world and significant delays in those who did arrive.
      • Garcia S.
      • Albaghdadi M.S.
      • Meraj W.M.
      • et al.
      Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic.
      J Am Coll Cardiol. 2020; 75: 2871-2872
      This led to a dramatic increase in mortality for patients with non-STEMI and STEMI with a higher rate of out-of-hospital cardiac arrest, cardiogenic shock, and late complications of acute myocardial infarction, including heart failure.
      • Nadarajah R.
      • Wu J.
      • Hurdus B.
      • et al.
      The collateral damage of COVID-19 to cardiovascular services: a meta-analysis.
      Eur Heart J. 2022; 43: 3164-3178
      These deleterious effects on cardiovascular outcomes have been documented in patients with and without COVID. In addition, there have been significant economic and psychologic impacts on patients throughout the world.
      We believe this outstanding collection of articles regarding both the direct and the indirect effects of the COVID-19 pandemic will help us to improve the care of cardiovascular patients.

      References

        • Madjid M.
        • Safavi-Naeini P.
        • Solomon S.D.
        • et al.
        Potential effects of coronaviruses on the cardiovascular system: a review.
        JAMA Cardiol. 2020; 5: 831-840
        View in Article
        • Gupta A.
        • Madhavan M.V.
        • Sehgal K.
        • et al.
        Extrapulmonary manifestations of COVID-19.
        Nat Med. 2020; 26: 1017-1032
        View in Article
        • Henry T.D.
        • Kereiakes D.J.
        The direct and indirect effects of the COVID-19 pandemic on cardiovascular disease throughout the world.
        Eur Heart J. 2022; 43: 1154-1156
        View in Article
        • Garcia S.
        • Dehghani P.
        • Grines C.
        • et al.
        Initial findings from the North American COVID-19 Myocardial Infarction Registry.
        J Am Coll Cardiol. 2021; 77: 1994-2003
        View in Article
        • Bhatt A.S.
        • Jering K.S.
        • Vaduganathan M.
        • et al.
        Clinical outcomes in patients with heart failure hospitalized with COVID-19.
        JACC Heart Fail. 2021; 9: 65-73
        View in Article
        • Alvarez-Garcia J.
        • Lee S.
        • Gupta A.
        • et al.
        Prognostic impact of prior heart failure in patients hospitalized with COVID-19.
        J Am Coll Cardiol. 2020; 76: 2334-2348
        View in Article
        • Gluckman T.J.
        • Bhave N.M.
        • et al.
        2022 ACC expert consensus decision pathway on cardiovascular sequelae of COVID-19 in adults: myocarditis and other myocardial involvement, post-acute sequelae of SARS-CoV-2 infection, and return to play: a report of the American College of Cardiology Solution Set Oversight Committee.
        J Am Coll Cardiol. 2022; 79: 1717-1756
        View in Article
        • Nadarajah R.
        • Wu J.
        • Hurdus B.
        • et al.
        The collateral damage of COVID-19 to cardiovascular services: a meta-analysis.
        Eur Heart J. 2022; 43: 3164-3178
        View in Article
        • Garcia S.
        • Albaghdadi M.S.
        • Meraj W.M.
        • et al.
        Reduction in ST-segment elevation cardiac catheterization laboratory activations in the United States during COVID-19 pandemic.
        J Am Coll Cardiol. 2020; 75: 2871-2872
        View in Article

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      DOI: https://doi.org/10.1016/j.hfc.2023.02.001

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      © 2023 Published by Elsevier Inc.

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