Right heart overload – possible long-term sequelae of Covid-19: a narrative review
DOI:
https://doi.org/10.34119/bjhrv7n2-210Keywords:
pulmonary microthrombi, Covid‐19, Sars‐Cov2, cardiovascular manifestations, right heart failure, thromboembolism, hypercoagulationAbstract
The United Nations announced the COVID-19 Pandemic in March 2019, and since then, many efforts have been made to understand better the multiple consequences of the virus on one's health. Notably, such viral infection leads to an increase in the formation of thrombi and microthrombi. However, mechanisms are not precise yet, neither are these complication consequences and management. It is essential to acknowledge these aspects of the disease, so patients receive better health care when dealing with COVID-19. This article's extensive search involved PubMed, SCOPUS, Cochrane, and Google Scholar databases; authors used keywords to find relevant studies on the subject. SARS-CoV2 creates a pro-thrombotic state through direct endothelial damage and a cytokine storm, affecting the lung, among other organs, leading to hypoxia and a rise in vascular resistance. Increased vascular resistance makes patients prone to cardiac stress, with a known association with right heart failure, among other insults to the heart. This condition affects both outpatients and inpatients, hypertension being a significant risk factor. The cardiac damage can be observed by cardiac injury biomarkers, imaging, and heart failure symptoms. Considering the massive number of infected during the pandemic, we suggest that right heart failure secondary to increased vascular resistance in the COVID/post-COVID state presents as a long-term sequel of the infection. Moreover, we believe it deserves attention so that patients may receive early and adequate health care.
References
Guo Y-R, Cao Q-D, Hong Z-S, Tan Y-Y, Chen S-D, Jin H-J, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak – an update on the status. Military Medical Research [Internet]. 2020 Mar 13;7(1). Available from: https://mmrjournal.biomedcentral.com/articles/10.1186/s40779-020-00240-0
Zhou P, Yang X-L, Wang X-G, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020 Feb 3;579(7798):270–3.
Devaux CA, Rolain J-M, Raoult D. ACE2 receptor polymorphism: Susceptibility to SARS-CoV-2, hypertension, multi-organ failure, and COVID-19 disease outcome. Journal of Microbiology, Immunology and Infection. 2020 May;53(3).
Loo J, Spittle DA, Newnham M. COVID-19, immunothrombosis and venous thromboembolism: biological mechanisms. Thorax [Internet]. 2021 Jan 5 [cited 2021 Mar 7]; Available from: https://thorax.bmj.com/content/early/2021/01/06/thoraxjnl-2020-216243#ref-36
Bryce YC, Perez-Johnston R, Bryce EB, Homayoon B, Santos-Martin EG. Pathophysiology of right ventricular failure in acute pulmonary embolism and chronic thromboembolic pulmonary hypertension: a pictorial essay for the interventional radiologist. Insights into Imaging. 2019 Feb 13;10(1).
Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020 Mar 26;368:m1091.
Adeghate EA, Eid N, Singh J. Mechanisms of COVID-19-induced heart failure: a short review. Heart Failure Reviews. 2020 Nov 16;
Hunt BJ, Levi M. Re The source of elevated plasma D‐dimer levels in COVID‐19 infection. British Journal of Haematology. 2020 Jun 18;190(3).
Li J-W, Han T-W, Woodward M, Anderson CS, Zhou H, Chen Y-D, et al. The impact of 2019 novel coronavirus on heart injury: A Systematic review and Meta-analysis. Progress in Cardiovascular Diseases. 2020 Jul;63(4):518–24.
Rathore SS, Rojas GA, Sondhi M, Pothuru S, Pydi R, Kancherla N, et al. Myocarditis associated with Covid‐19 disease: A systematic review of published case reports and case series. International Journal of Clinical Practice. 2021 Jul 7;
Italia L, Tomasoni D, Bisegna S, Pancaldi E, Stretti L, Adamo M, et al. COVID-19 and Heart Failure: From Epidemiology During the Pandemic to Myocardial Injury, Myocarditis, and Heart Failure Sequelae. Frontiers in Cardiovascular Medicine. 2021 Aug 10;8.
Puntmann VO, Carerj ML, Wieters I, Fahim M, Arendt C, Hoffmann J, et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiology [Internet]. 2020 Jul 27;5(11). Available from: https://jamanetwork.com/journals/jamacardiology/fullarticle/2768916
Acharya Y, Alameer A, Calpin G, Alkhattab M, Sultan S. A comprehensive review of vascular complications in COVID-19. Journal of Thrombosis and Thrombolysis. 2021 Nov 1;53(3):586–93.
Middeldorp S, Coppens M, van Haaps TF, Foppen M, Vlaar AP, Müller MCA, et al. Incidence of venous thromboembolism in hospitalized patients with COVID‐19. Journal of Thrombosis and Haemostasis. 2020 May 5;
Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers D, Kant KM, et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis. Thrombosis Research [Internet]. 2020 Apr 30; Available from: https://www.sciencedirect.com/science/article/pii/S0049384820301572
Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thrombosis Research. 2020 Jul;191:9–14.
Poissy J, Goutay J, Caplan M, Parmentier E, Duburcq T, Lassalle F, et al. Pulmonary Embolism in Patients With COVID-19. Circulation. 2020 Jul 14;142(2):184–6.
Simmons J, Pittet J-F. The coagulopathy of acute sepsis. Current Opinion in Anaesthesiology [Internet]. 2015 Apr;28(2):227–36. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4407200/
Magro CM, Mulvey J, Kubiak J, Mikhail S, Suster D, Crowson AN, et al. Severe COVID-19: A multifaceted viral vasculopathy syndrome. Annals of Diagnostic Pathology. 2021 Feb;50:151645.
Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, Harp J, et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Translational Research. 2020 Apr;
Chen W, Pan JY. Anatomical and Pathological Observation and Analysis of SARS and COVID-19: Microthrombosis Is the Main Cause of Death. Biological Procedures Online [Internet]. 2021 Jan 20;23. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816139/
Rapkiewicz AV, Mai X, Carsons SE, Pittaluga S, Kleiner DE, Berger JS, et al. Megakaryocytes and platelet-fibrin thrombi characterize multi-organ thrombosis at autopsy in COVID-19: A case series. EClinicalMedicine [Internet]. 2020 Jun 25;0(0). Available from: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30178-4/fulltext
do Espírito Santo DA, Lemos ACB, Miranda CH. In vivo demonstration of microvascular thrombosis in severe COVID-19. Journal of Thrombosis and Thrombolysis. 2020 Aug 13;50(4):790–4.
Zeng J-H, Liu Y-X, Yuan J, Wang F-X, Wu W-B, Li J-X, et al. First case of COVID-19 complicated with fulminant myocarditis: a case report and insights. Infection [Internet]. 2020 Apr 10; Available from: https://link.springer.com/article/10.1007%2Fs15010-020-01424-5
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. The Lancet. 2020 Jan 24;395(10223):497–506.
Modin D, Claggett B, Sindet-Pedersen C, Lassen MCH, Skaarup KG, Jensen JUS, et al. Acute COVID-19 and the Incidence of Ischemic Stroke and Acute Myocardial Infarction. Circulation. 2020 Nov 24;142(21):2080–2.
Becker RC. COVID-19 update: Covid-19-associated coagulopathy. J Thromb Thrombolysis [Internet]. 15 maio 2020 [citado 9 mar 2024];50(1):54-67. Disponível em: https://doi.org/10.1007/s11239-020-02134-3
Lin J, Yan H, Chen H, He C, Lin C, He H, Zhang S, Shi S, Lin K. COVID‐19 and coagulation dysfunction in adults: A systematic review and meta‐analysis. J Med Virol [Internet]. 2 ago 2020 [citado 9 mar 2024];93(2):934-44. Disponível em: https://doi.org/10.1002/jmv.26346
Lichtman M. A. Williams W. J. Kipps T. J. Seligsohn U. Kaushansky K. Prchal J. T. Beutler E. Abrams C. S. Agarwal A. M. & Agarwal N. (2010). Williams hematology (8th ed.). McGraw-Hill
Ahmed, S., Zimba, O., & Gasparyan, A. Y. (2020). Thrombosis in Coronavirus disease 2019 (COVID-19) through the prism of Virchow’s triad. Clinical Rheumatology, 39(9), 2529-2543.
Bonaventura, A., Vecchié, A., Dagna, L., Martinod, K., Dixon, D. L., Van Tassell, B. W., ... & Abbate, A. (2021). Endothelial dysfunction and immunothrombosis as key pathogenic mechanisms in COVID-19. Nature Reviews Immunology, 21(5), 319-329.
Varga, Z., Flammer, A. J., Steiger, P., Haberecker, M., Andermatt, R., Zinkernagel, A. S., ... & Moch, H. (2020). Endothelial cell infection and endotheliitis in COVID-19. The Lancet, 395(10234), 1417-1418.
Ortega‐Paz, L., Capodanno, D., Montalescot, G., & Angiolillo, D. J. (2021). Coronavirus disease 2019–associated thrombosis and coagulopathy: review of the pathophysiological characteristics and implications for antithrombotic management. Journal of the American Heart Association, 10(3), e019650.
Beyerstedt, S., Casaro, E. B., & Rangel, É. B. (2021). COVID-19: angiotensin-converting enzyme 2 (ACE2) expression and tissue susceptibility to SARS-CoV-2 infection. European journal of clinical microbiology & infectious diseases, 40(5), 905-919.
Zhang, S., Liu, Y., Wang, X., Yang, L., Li, H., Wang, Y., ... & Hu, L. (2020). SARS-CoV-2 binds platelet ACE2 to enhance thrombosis in COVID-19. Journal of hematology & oncology, 13(1), 1-22.
Voicu, S., Ketfi, C., Stépanian, A., Chousterman, B. G., Mohamedi, N., Siguret, V., ... & Bonnin, P. (2021). Pathophysiological processes underlying the high prevalence of deep vein thrombosis in critically ill COVID-19 patients. Frontiers in Physiology, 1680.
Abou-Ismail, M. Y., Diamond, A., Kapoor, S., Arafah, Y., & Nayak, L. (2020). The hypercoagulable state in COVID-19: Incidence, pathophysiology, and management. Thrombosis research, 194, 101-115.
Jiménez, D., García-Sanchez, A., Rali, P., Muriel, A., Bikdeli, B., Ruiz-Artacho, P., ... & Monreal, M. (2021). Incidence of VTE and bleeding among hospitalized patients with coronavirus disease 2019: a systematic review and meta-analysis. Chest, 159(3), 1182-1196.
Tan, B. K., Mainbourg, S., Friggeri, A., Bertoletti, L., Douplat, M., Dargaud, Y., ... & Lega, J. C. (2021). Arterial and venous thromboembolism in COVID-19: a study-level meta-analysis. Thorax, 76(10), 970-979
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 Cardiology. 2020 Mar 25;5(7).
Rey JR, Caro‐Codón J, Rosillo SO, Iniesta ÁM, Castrejón‐Castrejón S, Marco‐Clement I, et al. Heart failure in COVID‐19 patients: prevalence, incidence and prognostic implications. European Journal of Heart Failure. 2020 Oct 7;
Tsabedze N, Kraus S, Hitzeroth J, Ntsekhe M, Mpe M, Makotoko M. COVID-19 and heart failure. SA Heart. 2020 Nov;17(3).
Szekely Y, Lichter Y, Taieb P, Banai A, Hochstadt A, Merdler I, et al. Spectrum of Cardiac Manifestations in COVID-19. Circulation. 2020 Jul 28;142(4):342–53.
Jain SS, Liu Q, Raikhelkar J, Fried J, Elias P, Poterucha TJ, et al. Indications for and Findings on Transthoracic Echocardiography in COVID-19. Journal of the American Society of Echocardiography. 2020 Oct;33(10):1278–84.
Lan Y, Liu W, Zhou Y. Right Ventricular Damage in COVID-19: Association Between Myocardial Injury and COVID-19. Frontiers in Cardiovascular Medicine. 2021 Feb 16;8.
Fox SE, Akmatbekov A, Harbert JL, Li G, Brown JQ, Heide RSV. Pulmonary and Cardiac Pathology in Covid-19: The First Autopsy Series from New Orleans. 2020 Apr 10;
Fauvel C, Trimaille A, Weizman O, Pezel T, Mika D, Waldmann V, et al. Cardiovascular manifestations secondary to COVID-19: A narrative review. Respiratory Medicine and Research. 2022 May;81:100904.
Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: The Task Force on Acute Heart Failure of the European Society of Cardiology. European Heart Journal. 2005 Jan 25;26(4):384–416.
Poissy J, Goutay J, Caplan M, Parmentier E, Duburcq T, Lassalle F, et al. Pulmonary Embolism in Patients With COVID-19. Circulation. 2020 Jul 14;142(2):184–6.
World Health Organization. WHO COVID-19 dashboard [Internet]. World Health Organization. World Health Organization; 2022. Available from: https://covid19.who.int/
Aktaa S, Wu J, Nadarajah R, Rashid M, de Belder M, Deanfield J, et al. Incidence and mortality due to thromboembolic events during the COVID-19 pandemic: Multi-sourced population-based health records cohort study. Thrombosis Research [Internet]. 2021 Jun 1 [cited 2022 Jan 3];202:17–23. Available from: https://www.sciencedirect.com/science/article/pii/S0049384821000979
Suh Y, Hong H, Ohana M, Bompard F, Revel M, Valle C, et al. Pulmonary Embolism and Deep Vein Thrombosis in COVID-19: A Systematic Review and Meta-Analysis. Radiology. 2021 Feb 28; 298(2): E70–E80. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745997/pdf/radiol.2020203557.pdf
Overstad S, Tjonnfjord E, Garabet L, Fronas S, Bergan J, Aballi S, et al. Venous thromboembolism and coronavirus disease 2019 in an ambulatory care setting - A report of 4 cases. Thrombosis Research. 2020 Oct;194:116–8.
Gervaise A, Bouzad C, Peroux E, Helissey C. Acute pulmonary embolism in non-hospitalized COVID-19 patients referred to CTPA by emergency department. European Radiology. 2020 Jun 9;
Uppuluri EM, Shapiro NL. Development of pulmonary embolism in a nonhospitalized patient with COVID-19 who did not receive venous thromboembolism prophylaxis. American Journal of Health-System Pharmacy. 2020 Aug 11;77(23):1957–60.
Dhawan RT, Gopalan D, Howard L, Vicente A, Park M, Manalan K, et al. Beyond the clot: perfusion imaging of the pulmonary vasculature after COVID-19. The Lancet Respiratory Medicine. 2021 Jan;9(1):107–16.
Zhao S, Friedman O. Management of Right Ventricular Failure in Pulmonary Embolism. Critical Care Clinics. 2020 Jul;36(3):505–15.
Xiang-hua Y, Le-min W, Ai-bin L, Zhu G, Riquan L, Xu-you Z, et al. Severe Acute Respiratory Syndrome and Venous Thromboembolism in Multiple Organs. American Journal of Respiratory and Critical Care Medicine. 2010 Aug 1;182(3):436–7.
Lee N, Hui D, Wu A, Chan P, Cameron P, Joynt GM, et al. A Major Outbreak of Severe Acute Respiratory Syndrome in Hong Kong. New England Journal of Medicine. 2003 May 15;348(20):1986–94.
Higgins V, Sohaei D, Diamandis EP, Prassas I. COVID-19: from an acute to chronic disease? Potential long-term health consequences. Critical Reviews in Clinical Laboratory Sciences [Internet]. 2020 Dec 21;58(5):1–23. Available from: https://pubmed.ncbi.nlm.nih.gov/33347790/
Konstam MA, Kiernan MS, Bernstein D, Bozkurt B, Jacob M, Kapur NK, et al. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association. Circulation. 2018 May 15;137(20).
