Myocardial remodeling in patients with coronavirus infection and concomitant coronary heart diseaseas

   The analysis of cytokine profile markers with reference to the clinical and functional features of the heart condition in case of new coronavirus infection (COVID-19) can provide valuable information about the pathogenetic mechanisms of cardiovascular complications and be considered as an additional factor of unfavorable prognosis in patients with concomitant coronary heart disease (CHD).

   Aim. To study the clinical and functional features of the heart condition and the expanded cytokine profile in hospitalized patients with COVID-19 coronavirus infection and concomitant coronary artery disease.

   Material and methods. The retrospective study included an analysis of medical documentation to determine the main characteristics of patients, mortality rates, assessment of the polymorbid background, and autopsy results in 247 patients hospitalized with COVID-19. The prospective study included 90 patients undergoing inpatient treatment in the cardiology department with a diagnosis of COVID-19. The patients were divided into 2 groups: group 1 represented by patients with COVID-19 and coronary heart disease (n = 42), group 2 – patients with COVID-19 without coronary heart disease (n = 48). The examination of patients included the determination of standard biochemical parameters, assessment of the cytokine profile (48 cytokines and chemokines), echocardiography (ECHO), computed tomography of the lungs (CT).

   Results. In the study of autopsy material of the cardiovascular system, left ventricular hypertrophy was detected in 185 patients (74.9 %). According to the results of the conducted studies, the highest values of inflammatory cytokinesinterleukins(IL): IL-1, IL-6,granulocyte colony-stimulating factor (G-CSF), monocyte chemoattractant protein-1(MCP-1),interferon γ-induced protein-10 (IP-10), macrophage inflammatory protein-1b(MIP-1b), tumor necrosis factor-a(TNF-a) were observed in group 1 relative to group 2. A positive relationship was revealed between the level of C-reactive protein and IL-2, IL-6, IL-7,IL-17a, G-CSF, MCP-1, IP-10, macrophage inflammatory protein-1a(MIP1a), MIP1b, TNFa, ferritin and IL-2, IL-6, IL-17a, G-CSF, MCP-1, IP-10, MIP1a, MIP1b, TNFa, as well as between the D-dimer level and IL-2, IL-6, IL-7, IL-17a, MIP1a, MIP1b, TNF-a. According to ECHO data, a statistically significant increase in the longitudinal size of the right atrium, the level ofmeanpulmonary artery pressure (mPAP), and an expansion of the transverse size of the left atrium were revealed in group 1 compared with group 2 (p < 0.05).

   Conclusion. Based on the findings obtained regarding pronounced systemic inflammation that develops in patients with coronavirus infection associated with concomitant coronary heart disease, it resulting in rapidly developing morpho-functional changes in the myocardium, coronavirus infection can be considered as a factor exacerbating the further course of coronary heart disease.

1. Shi S., Qin M., Shen B., Cai Y., Liu T., Yang F. et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol. 2020, vol. 5(7), pp. 802-810. doi: 10.1001/jamacardio.2020.0950.

2. 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, vol. 5(7), pp. 811-818. doi: 10.1001/jamacardio.2020.1017.

3. Tay M.Z., Poh C.M., Rénia L., MacAry P.A., Ng L.F. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol, 2020, vol. 20(6), pp. 363-374. doi: 10.1038/s41577-020-0311-8.

4. Arutyunov G.P., Tarlovskaya E.I., Arutyunov A.G., BelenkovYu.N., Konradi A.O., Lopatin Yu.M. et al. Analysis of the Impact of Comorbid Cardiovascular Pathology to the Course of COVID-19 and its’ Outcomes in Inpatients Admitted to Hospital During the First and the Second Waves of the Novel Coronavirus Infection in the Eurasian Regionе. Kardiologiia, 2022, vol. 62(11), pp. 38-49. (in Russian).

5. The Task Force for the management of COVID-19 of the European Society of Cardiology. European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1-epidemiology, pathophysiology, and diagnosis. Eur Heart J, 2022, vol. 43(11), pp. 1033-1058. doi: 10.1093/eurheartj/ehab696.

6. Sasayama S., Okada M., Matsumori A. Chemokines and cardiovascular diseases, Cardiovasc Res, 2000, vol. 45(2), pp. 267-269. doi: 10.1016/S0008-6363(99)00381-8.

7. Lee W.H., Kim S.H., Lee Y., Lee B.B., Kwon B., Song H., et al. Tumor necrosis factor receptor superfamily 14 is involved in atherogenesis by inducing proinflammatory cytokines and matrix metalloproteinases. ArteriosclerThrombVasc Biol, 2001, vol. 21(12), pp. 2004-2010. doi: 10.1161/hq1201.098945.

8. Dri E., Lampas E., Lazaros G., Lazarou E., Theofilis P., Tsioufis C., et al. Inflammatory Mediators of Endothelial Dysfunction. Life (Basel), 2023, vol. 13(6), pp. 1420. doi: 10.3390/life13061420.

9. Oleinikov V.E., Avdeeva I.V., Polezhaeva K.N., Pavlenko K.I., Borisova N.A., Khromova A.A. at al. Structural and functional properties of arteries in COVID-19 survivors. Cardiovascular Therapy and Prevention, 2023, vol. 22(5), pp. 3541. (in Russian).

10. Aydın E., Kant A., Yilmaz G. Evaluation of the cardio-ankle vascular index in COVID-19 patients. Rev Assoc Med Bras (1992), 2022, vol. 68(1), pp. 73-76. doi:10.1590/1806-9282.20210781.

11. Lambadiari V, Mitrakou A, Kountouri A, et al. Association ofCOVID-19 with impaired endothelial glycocalyx, vascular functionand myocardial deformation 4 months after infection. Eur J HeartFail, 2021, vol. 23(11), pp. 1916-1926. doi:10.1002/ejhf.2326.

12. Statsenko M.E., Derevyanchenko M.V. The role of systemic inflammation in decrease of elasticity of magistral arteries and in progression of endothelial dysfunction in patients with systemic hypertension, obesity and type 2 diabetes. Russian Journal of Cardiology, 2018, vol. (4), pp. 32-36. doi:10.15829/1560-4071-2018-4-32-36. (in Russian).

13. Ministry of Health of the Russian Federation. Temporary clinical recommendations. Prevention, diagnosis and treatment of new coronavirus infection (COVID-19). Version 7(3.06.2020). (in Russian).

14. Ministry of Health of the Russian Federation. Clinical recommendations. Stable ischemic heart disease. 2020. (in Russian).

15. Arutyunov G.P., Tarlovskaya E.I., Arutyunov A.G., et al. International register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors” (AKTIV) and the register “Analysis of hospitalizations of comorbid patients infected during the second wave of SARSCoV-2 outbreak” (AKTIV 2). Russian Journal of Cardiology, 2021, vol. 26(3), pp. 4358. doi: 10.15829/1560-4071-2021-4358. (in Russian).

16. Selyutina A.G. Changes in the functional state of the heart in a new coronavirus infection (COVID-19). Fundamental research in chemistry, biology and ecology: Materials of the International student scientific and practical conference, Orenburg, October 24-25, 2022. Orenburg: Orenburg State University, 2022. pp. 262-264. (inRussian).