新型冠状病毒感染心肌损伤无创影像学评估中国专家共识

新型冠状病毒感染（COVID-19）患者出现心血管不适症状较为常见，及时识别心肌损伤至关重要。多模态影像学评估手段在评估心肌损伤、诊断病因、危险分层及预后管理中发挥重要作用。本共识针对疑似COVID-19相关心肌损伤的患者，根据不同临床表现及适应证，以专家共识的方式推荐了针对心肌损伤的无创影像检查优选策略；并对比了各种无创心血管影像学检查的价值和优缺点，以便更好地为疑似COVID-19相关心肌损伤的患者提供准确的诊断和治疗监测。     

31例新型冠状病毒肺炎死亡患者并发心脏损害的临床分析

目的:分析新型冠状病毒肺炎(COVID-19)死亡患者的临床特征,重点分析心脏损害情况和潜在发生机制.方法:回顾性分析湖北省黄冈市中心医院大别山区域医疗中心收治的31例COVID-19死亡患者的血常规、生化、血气分析、心肌损伤标志物、炎症因子、影像学、电生理检查等临床资料,比较患者入院首次检测指标与死亡前最后一次复查指...     

新型冠病毒肺炎合并心肌损伤机制及处理原则浅析

新型冠状病毒肺炎(COVID-19)于2019年12月在中国武汉出现,后经确认为新型冠状病毒感染所致,该新型冠状病毒属于β冠状病毒属,与人类SARS冠状病毒及中东呼吸综合征冠状病毒类似,均可感染人类。该肺炎虽主要引起呼吸道症状,但报道称部分患者合并心肌损伤。本综述简要探讨COVID-19合并心肌损伤可能机制,为抗疫一线医师治疗合并心肌损伤的COVID-19患者提供参考。     

新型冠状病毒肺炎相关心肌损伤患者的临床特点及危险因素

目的 探讨新型冠状病毒肺炎（coronavirus disease 2019,COVID-19）相关心肌损伤患者的危险因素，为临床早期筛查、及时干预提供理论依据。方法 收集2020年2月19日至2020年3月28日收治在武汉协和医院九楼病房的COVID-19患者的临床资料，根据是否合并心肌损伤将患者分为非心肌损伤组（对照组）142例和心肌损伤组24例。比较两组患者的临床特点、实验室指标、影像学检查结果及治疗情况；采用Logistic回归分析对COVID-19相关心肌损伤的危险因素进行分析。结果 单因素分析发现铁蛋白、白细胞介素-6(interleukin-6,IL-6)、C反应蛋白（C-reactive protein,CRP）、氧合指数（oxygenation index,OI）、肺部病变范围>50%发生比率及重型/危重型发生比率在心肌损害组和对照组间患者比较，差异均具有统计学意义（P<0.05）。多因素Logistic回归分析比较：CRP、肺部病变范围>50%与心肌损害的发生呈正相关，OI与心肌损害的发生呈负相关（P<0.05）；其中CRP的影响最大（OR=...     

新型冠状病毒肺炎相关心肌损伤的诊疗进展

新型冠状病毒肺炎(COVID-19)患者除了典型的呼吸系统表现,也有一定比例的患者出现心脏受累的临床表现。常起病隐匿且恶化迅速,短期内可进展为急性左心衰竭、顽固性休克或致命性心律失常,因此早期识别,并根据患者所处疾病的不同阶段实施有针对性的治疗措施,对于降低COVID-19患者死亡率,改善重型及危重型患者的预后至关重要。本文将结合最新文献报道和作者团队的诊治经验对COVID-19相关心肌损伤的定义、发病机制、临床评估和治疗方案做一综述。     

新型冠状病毒肺炎心肌损伤临床病理与影像学研究进展

由新型冠状病毒(SARS-CoV-2)感染引起的新型冠状病毒肺炎(COVID-19)严重威胁人类健康.随着确诊病例数增加和研究深入,发现COVID-19主要侵犯呼吸系统,还可累及心肌及其他重要脏器.本文对CO-VID-19相关心肌损伤的病理生理学机制、临床特征、影像学评估等进行综述,以期为COVID-19患者心肌损伤的...     

新型冠状病毒肺炎患者心肌损伤标志物初步探讨

目的:初步探讨不同临床分型新型冠状病毒肺炎(COVID-19)患者心肌损伤标志物特征。方法:本研究是一项回顾性单中心研究,纳入了2020年1月至2020年2月,共122例COVID-19确诊病例,其中轻型/普通型共92例,重型/危重型共30例。通过实时RT-PCR确诊病例,并收集流行病学,人口统计学,临床分析,放射学特征和实验室数据。结果:根据患者病情临床分型,将所有COVID-19患者分为两组,一组为轻型和普通型,另一组为重型/危重型患者。比较两组患者一般情况结果显示:重症/危重型COVID-19患者年龄、WBC、中性粒细胞百分比、血清淀粉样蛋白A、尿素氮、谷草转氨酶、心率、体温、呼吸次数、死亡率和肺部病变范围均高于轻型/普通型患者,而淋巴细胞数、淋巴细胞百分比和血氧饱和度则低于轻型/普通型患者(P<0.05)。比较不同病情分型COVID-19患者心肌损伤标志物水平和急性心肌受损的比例结果提示:重型/危重型患者心肌酶指标、心肌酶升高所占比例和hs-cTnI水平均高于轻型/普通型患者,急性心肌受损的比例(11.1%vs.42.3%)也明显升高(P<0.05)。结论:重症COVID-19患者发生急性心肌损伤的比例为42.3%;重症COVID-19患者心肌酶、hs-cTnI水平高于轻症患者。     

新型冠状病毒肺炎合并心血管基础疾病的临床特点及心肌损伤的病理生理机制

新型冠状病毒肺炎(COVID-19)自暴发以来,已造成全球大流行。其心血管损伤的临床表现主要包括心律失常、心原性休克和急性心肌损伤等。而合并心血管基础疾病的COVID-19患者疾病进展更迅速,死亡率更高。本文对细胞因子风暴和血管紧张素转换酶2表达失衡导致心脏损伤进行文献复习,希望对制定临床对策有一定的启示作用。     

新型冠状病毒感染相关心肌损伤研究现状

2019年年末,由严重急性呼吸综合征冠状病毒2(severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)引起的新型冠状病毒感染(coronavirus disease 2019,COVID-19)迅速扩散,在全球范围内出现大流行,由于其毒株变异速度快、传染性强,给世界各国带来了沉重的医疗负担和经济负担。COVID-19可累及全身多个系统,除了典型的呼吸系统症状外,COVID-19患者还可并发心肌损伤。随着研究的不断深入,目前对COVID-19相关心肌损伤的认知也得到进一步提升。笔者对COVID-19相关心肌损伤的研究现状作一综述,以加深临床医生对该疾病的认识。     

新型冠状病毒病（COVID-19）并发心肌损伤的研究现状

新型冠状病毒病（coronavirus disease 2019,COVID-19）是由急性呼吸综合征新型冠状病毒（SARS-CoV-2）引起的一种感染性极强的严重呼吸系统综合征,目前已形成世界性大爆发,给人类健康和全球经济带来了极大的影响。现有研究表明,COVID-19除了影响呼吸系统外,还对心血管系统有侵害作用,引起心肌损伤,预后较差。本文就现有的COVID-19并发心肌损伤的病原学、潜在的发病机制、相关临床表现特征、治疗原则及预后等方面研究进行论述,旨在加深临床医师对COVID-19并发心肌损伤的认识。     

生长刺激表达基因2蛋白因子在新型冠状病毒肺炎患者心血管事件诊断及预后判断中的作用和应用前景

新型冠状病毒肺炎疫情自武汉爆发以来,已在全国范围出现流行趋势。对危重症患者临床救治过程中发现,患有心血管疾病、糖尿病等基础疾病的老年患者死亡风险更高。同时发现多数危重症患者出现心肌损伤、心功能衰竭等心血管功能受损情况,临床迫切需要能够尽早识别心肌损伤的指标和方法,这对提高新型冠状病毒肺炎危重症患者的救治成功率至关重要。生长刺激表达基因2蛋白(ST2)是一种血浆蛋白,是白介素-33的配体,作为新型心力衰竭及心肌损伤标志物,依据其独特信号传导通路和病理生理机制,有望与脑利钠肽等指标联合应用,对新型冠状病毒肺炎患者心力衰竭及心肌损伤诊疗及预后提供参考依据。     

Heart and Lung Multimodality Imaging in COVID-19

The severe acute respiratory syndrome-coronavirus-2 outbreak has rapidly reached pandemic proportions and has become a major threat to global health. Although the predominant clinical feature of coronavirus disease-2019 (COVID-19) is an acute respiratory syndrome of varying severity, ranging from mild symptomatic interstitial pneumonia to acute respiratory distress syndrome, the cardiovascular system can be involved in several ways. As many as 40% of patients hospitalized with COVID-19 have histories of cardiovascular disease, and current estimates report a proportion of myocardial injury in patients with COVID-19 of up to 12%. Multiple pathways have been suggested to explain this finding and the related clinical scenarios, encompassing local and systemic inflammatory responses and oxygen supply-demand imbalance. From a clinical point of view, cardiac involvement during COVID-19 may present a wide spectrum of severity, ranging from subclinical myocardial injury to well-defined clinical entities (myocarditis, myocardial infarction, pulmonary embolism, and heart failure), whose incidence and prognostic implications are currently largely unknown because of a significant lack of imaging data. Integrated heart and lung multimodality imaging plays a central role in different clinical settings and is essential in the diagnosis, risk stratification, and management of patients with COVID-19. The aims of this review are to summarize imaging-oriented pathophysiological mechanisms of lung and cardiac involvement in COVID-19 and to provide a guide for integrated imaging assessment in these patients.     

新型冠状病毒肺炎和心血管疾病关系的研究进展

当前,由严重急性呼吸综合征冠状病毒2(SARS-CoV-2)引发的新型冠状病毒肺炎(COVID-19)疫情在全球蔓延。SARS-CoV-2主要通过血管紧张素转换酶2(ACE2)受体感染宿主细胞,在引起呼吸系统损伤的同时,也造成急性心肌损伤和慢性心血管疾病。COVID-19患者合并心血管疾病也十分常见,对患者的预后有显著...     

新型冠状病毒肺炎累及心脏的表现和治疗建议

由于新型冠状病毒具有传播能力强、临床表现多样、潜伏期长、可隐性传染等特征,目前全球累计已有超过480万人被感染,新型冠状病毒肺炎患者除了典型的呼吸系统表现外,心脏受累亦不少见,本文通过目前可获得的文献和临床资料,对新型冠状病毒肺炎患者心脏受累的流行病学特征、可能机制、临床表现进行了总结,并结合自身一线抗疫临床经验对新型冠状病毒肺炎合并心脏受累的治疗进行了讨论,以供临床一线医师参考。     

Cardiovascular disease and COVID-19

Background and aimsMany patients with coronavirus disease 2019 (COVID-19) have underlying cardiovascular (CV) disease or develop acute cardiac injury during the course of the illness. Adequate understanding of the interplay between COVID-19 and CV disease is required for optimum management of these patients.MethodsA literature search was done using PubMed and Google search engines to prepare a narrative review on this topic.ResultsRespiratory illness is the dominant clinical manifestation of COVID-19; CV involvement occurs much less commonly. Acute cardiac injury, defined as significant elevation of cardiac troponins, is the most commonly reported cardiac abnormality in COVID-19. It occurs in approximately 8–12% of all patients. Direct myocardial injury due to viral involvement of cardiomyocytes and the effect of systemic inflammation appear to be the most common mechanisms responsible for cardiac injury. The information about other CV manifestations in COVID-19 is very limited at present. Nonetheless, it has been consistently shown that the presence of pre-existing CV disease and/or development of acute cardiac injury are associated with significantly worse outcome in these patients.ConclusionsMost of the current reports on COVID-19 have only briefly described CV manifestations in these patients. Given the enormous burden posed by this illness and the significant adverse prognostic impact of cardiac involvement, further research is required to understand the incidence, mechanisms, clinical presentation and outcomes of various CV manifestations in COVID-19 patients.     

Cardiovascular Magnetic Resonance for Patients With COVID-19

COVID-19 is associated with myocardial injury caused by ischemia, inflammation, or myocarditis. Cardiovascular magnetic resonance (CMR) is the noninvasive reference standard for cardiac function, structure, and tissue composition. CMR is a potentially valuable diagnostic tool in patients with COVID-19 presenting with myocardial injury and evidence of cardiac dysfunction. Although COVID-19–related myocarditis is likely infrequent, COVID-19–related cardiovascular histopathology findings have been reported in up to 48% of patients, raising the concern for long-term myocardial injury. Studies to date report CMR abnormalities in 26% to 60% of hospitalized patients who have recovered from COVID-19, including functional impairment, myocardial tissue abnormalities, late gadolinium enhancement, or pericardial abnormalities. In athletes post–COVID-19, CMR has detected myocarditis-like abnormalities. In children, multisystem inflammatory syndrome may occur 2 to 6 weeks after infection; associated myocarditis and coronary artery aneurysms are evaluable by CMR. At this time, our understanding of COVID-19–related cardiovascular involvement is incomplete, and multiple studies are planned to evaluate patients with COVID-19 using CMR. In this review, we summarize existing studies of CMR for patients with COVID-19 and present ongoing research. We also provide recommendations for clinical use of CMR for patients with acute symptoms or who are recovering from COVID-19.     

Biomarcadores de Lesão Miocárdica e Complicações Cardíacas Associadas à Mortalidade em Pacientes com COVID-19

BackgroundSARS-CoV-2 is an emerging RNA virus associated with a severe acute respiratory disease known as COVID-19. Although COVID-19 is predominantly a pulmonary disease, some patients have severe cardiovascular damage. We performed a quantitative evidence synthesis of clinical data, myocardial injury biomarkers, and cardiac complications associated with in-hospital death in patients with COVID-19.MethodsWe searched the databases PubMed, Embase, and Google Scholar to identify studies comparing clinical data, myocardial injury biomarkers, and cardiac complications between non-survivors and survivors of COVID-19. Effect sizes were reported as mean difference or standardized mean difference for continuous variables and risk ratio for dichotomous variables with 95% confidence intervals. A random effects model was used to pool the results.ResultsSix retrospective studies reporting data from 1,141 patients (832 survivors and 309 non-survivors) were included. We found that underlying cardiovascular conditions; elevation of high-sensitivity cardiac troponin I, N-terminal pro-B-type natriuretic peptide, and creatine kinase-MB; and cardiac complications were associated with increased risk of death for patients with SARS-CoV-2 infection.ConclusionsThe confirmation that underlying cardiovascular conditions, elevation of myocardial injury biomarkers during COVID-19 infection, and acute cardiovascular decompensation are predictors for mortality in SARS-CoV-2 infection must encourage new research to clarify potential mechanisms and test appropriate treatments. (Arq Bras Cardiol. 2020; 115(2):273-277)     

Involvement of cardiovascular system as the critical point in coronavirus disease 2019 (COVID-19) prognosis and recovery

The novel coronavirus disease 2019 (COVID-19) pandemic has already caused more than 300,000 deaths worldwide. Several studies have elucidated the central role of cardiovascular complications in the disease course. Herein, we provide a concise review of current knowledge regarding the involvement of cardiovascular system in the pathogenesis and prognosis of COVID-19. We summarize data from 21 studies involving in total more than 21,000 patients from Asia, Europe, and the USA indicating that severe disease is associated with the presence of myocardial injury, heart failure, and arrhythmias. Additionally, we present the clinical and laboratory differences between recovered and deceased patients highlighting the importance of cardiac manifestations. For the infected patients, underlying cardiovascular comorbidities and particularly existing cardiovascular disease seem to predispose to the development of cardiovascular complications, which are in turn associated with higher mortality rates. We provide mechanistic insights into the underlying mechanisms including direct myocardial damage by the virus and the consequences of the hyperinflammatory syndrome developed later in the disease course. Finally, we summarize current knowledge on therapeutic modalities and recommendations by scientific societies and experts regarding the cardiovascular management of patients with COVID-19.