PATHOGENETIC FEATURES OF THE DEVELOPMENT AND PROGRESSION OF HEART DAMAGE IN COVID-19

Objective. lo investigate the pathogenetic features of the development and progression of heart damage in COVID-19, by estimating the pretest probability of coronary heart disease CHD) in patients at 3 months after the illness. Subjects and methods. Clinical and laboratory parameters were analyzed in 180 patients who had received inpatient treatment for diagnosed and confirmed moderate novel coronavirus disease (COVID-19) and had no history of cardiac disease. In addition to the standard laboratory examination, the levels of biochemical, immunological, and cardiac markers, such as IFN-а, IL-6, IL-17, macrophage inflammatory protein (MIP-1P), brain natriuretic peptide (NT-proBNP), troponin I, fatty acid binding protein, and C-reactive protein were studied over time. Results. On days 7 to 10 after illness onset, the patients with moderate COVID-19 were found to have elevated levels of the markers of myocardial damage [troponin I (53.3%), fatty acid binding protein (8.8%)] and myocardial dysfunction [NT-proBNP (45%)]. By the 2nd week of hospitalization, the number of patients with the elevated level of troponin I increased up to 68.3% and that of NT-proBNP decreased to 26.7%. There was a direct correlation between the increase in the above markers with the levels of IL-6 and IL-17, as well as with the concentration of MIP-1P and there was an inverse correlation with the level of IFN-а. ECG revealed signs of myocardial ischemia, cardiac hypertrophy and overload, and arrhythmia. At 3 months after recovery, 20% of the examinees complained of heart area pains that were not recorded before COVID-19, of whom 58.3% of patients were noted to have a pretest probability of 15-85% for CHD, which justifies the need for additional cardiac imaging tests after COVID-19 infection. Conclusion. Comprehensive analysis of clinical complaints, biochemical and immunological parameters, and ECG and echocardiography data in patients with moderate COVID-19 could diagnose the development of acute myocardial damage in 43.8%, exertional angina pectoris in 11.2%, arrhythmia in 27%, and heart failure in 14.7%.

COVID-19, COVID-19, myocardial damage, myocardial dysfunction, troponin, coronary heart disease