A modern pathogenetic concept for developing diagnostic criteria for cardiac injury in patients with past COVID-19 infection

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Abstract

The COVID-19 pandemic was accompanied not only by the development of acute respiratory pathology but also by an increase in the incidence of delayed cardiovascular complications, indicating the presence of complex pathogenetic interactions in the virus-host system. The multisystem nature of the disease, driven by several key mechanisms, has now been established. The first is related to the virus’s tropism for tissues expressing the angiotensin-converting enzyme 2 receptor, leading to an imbalance in the renin-angiotensin system (RAAS) with predominant proinflammatory, vasoconstrictor, and prothrombotic effects. The second is the ability of SARS-CoV-2, which has a tropism for cardiac tissue, to initiate a signaling cascade of cardiomyocyte necroptosis. The third mechanism is mediated by virus-induced hypomethylation of the promoter regions of genes encoding proinflammatory cytokines, which contributes to the development of chronic systemic inflammation and damage to the vascular endothelium.

Conclusion. To identify the leading pathogenetic mechanism, promptly predict the risk of cardiovascular complications, and determine patient management strategies, it is necessary to develop and implement a strategy for the qualitative and quantitative assessment of specific biological markers into clinical practice. Their implementation will reduce disability and mortality rates among individuals who have recovered from COVID-19.

About the authors

Alexey V. Ageikin

Penza State University

Author for correspondence.
Email: ageykinav@yandex.ru
ORCID iD: 0000-0001-5092-4744

Cand. Med. Sci., Associate Professor, Department of Infectious Diseases, Medical Institute

Russian Federation, Penza

Alexander V. Gorelov

Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being

Email: agorelov_05@mail.ru
ORCID iD: 0000-0001-9257-0171

Academician of the Russian Academy of Sciences, MD, Professor, Deputy Director for Research

Russian Federation, Moscow

Denis V. Usenko

Penza State University; Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being

Email: dusenko@rambler.ru
ORCID iD: 0000-0001-5232-7337

MD, Associate Professor, Department of Infectious Diseases, Medical Institute; Leading Researcher, Clinical Department of Infectious Pathology

Russian Federation, Penza; Moscow

Sergey B. Rybalkin

Penza State University

Email: svmp@penzadom.ru
ORCID iD: 0000-0002-2933-5758

Honored Doctor of the Russian Federation, Cand. Med. Sci., Associate Professor, Department of Infectious Diseases, Medical Institute

Russian Federation, Penza

Dzhamilya Yu. Kurmaeva

Penza State University

Email: d.kurmaeva@yandex.ru
ORCID iD: 0000-0001-7989-7647

Cand. Med. Sci., Associate Professor, Department of Infectious Diseases, Medical Institute

Russian Federation, Penza

Veronika E. Bogonina

Penza State University

Email: bogoninaveronika@yandex.ru
ORCID iD: 0009-0004-2518-4034

5th-year student, Faculty of Medicine, Pediatrics specialty, Medical Institute

Russian Federation, Penza

Ramziya R. Davydova

Penza State University

Email: davydova03rr@list.ru
ORCID iD: 0009-0003-8919-7136

5th-year student, Faculty of Medicine, Pediatrics specialty, Medical Institute

Russian Federation, Penza

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