COVID-19 related cardiac complications - from clinical evidences to basic mechanisms. Opinion paper of the ESC Working Group on Cellular Biology of the Heart

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DOI

  • Maurizio Pesce, Centro Cardiologico Monzino, Milan
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  • Piergiuseppe Agostoni, Centro Cardiologico Monzino, Milan
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  • Hans-Erik Bøtker
  • Bianca Brundel, Amsterdam University Medical Centers (UMC)
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  • Sean M Davidson, London Ctr Nanotechnol, University College London, University of London
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  • Raffaele De Caterina, University of Pisa
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  • Peter Ferdinandy, Semmelweis Univ, Semmelweis University, Heart & Vasc Ctr
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  • Henrique Girao, Institute for Clinical and Biomedical Research (iCBR)
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  • Mariann Gyöngyösi, Medical University Vienna, Vienna
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  • Jean-Sebastien Hulot, Univ Paris 11, Universite Paris Saclay, UNICANCER, Universite Paris Sud - Paris 11, Gustave Roussy, Universite Paris Saclay (ComUE), Inst Gustave Roussy, Dept Med
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  • Sandrine Lecour, Univ Cape Town, University of Cape Town, Dept Anesthesiol
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  • Cinzia Perrino, Univ Naples Federico II, University of Naples Federico II, Dept Neurosci Reprod & Odontostomatol Sci
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  • Rainer Schulz, Justus Liebig Univ Giessen, Justus Liebig University Giessen, Dept Dermatol & Allergol, Univ Med Ctr Giessen & Marburg
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  • Joost P G Sluijter, Univ Utrecht, Utrecht University Medical Center, Utrecht University, Univ Med Ctr Utrecht, Regenerat Med Ctr
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  • Sabine Steffens, Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University (LMU), Munich, Germany.
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  • Ivan Tancevski, Univ Klin Innsbruck, Medical University of Innsbruck
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  • Can Gollmann-Tepeköylü, Univ Klin Innsbruck, Medical University of Innsbruck
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  • Carsten Tschöpe, Charite, Free University of Berlin, Humboldt University of Berlin, Charite Medical University of Berlin, Charite Mitte Campus, Dept Psychiat & Psychotherapy
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  • Sophie van Linthout, Charite, Free University of Berlin, Humboldt University of Berlin, Charite Medical University of Berlin, Charite Mitte Campus, Dept Psychiat & Psychotherapy
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  • Rosalinda Madonna, University of Pisa

The pandemic of Coronavirus disease (COVID)-19 is a global threat, causing high mortality, especially in the elderly. The main symptoms and the primary cause of death are related to interstitial pneumonia. Viral entry also into myocardial cells mainly via the angiotensin converting enzyme type 2 (ACE2) receptor and excessive production of pro-inflammatory cytokines, however, also make the heart susceptible to injury. In addition to the immediate damage caused by the acute inflammatory response, the heart may also suffer from long-term consequences of COVID-19, potentially causing a post-pandemic increase in cardiac complications. Although the main cause of cardiac damage in COVID-19 remains coagulopathy with micro- (and to a lesser extent macro-) vascular occlusion, open questions remain about other possible modalities of cardiac dysfunction, such as direct infection of myocardial cells, effects of cytokines storm, and mechanisms related to enhanced coagulopathy. In this opinion paper, we focus on these lesser appreciated possibilities and propose experimental approaches that could provide a more comprehensive understanding of the cellular and molecular bases of cardiac injury in COVID-19 patients. We first discuss approaches to characterize cardiac damage caused by possible direct viral infection of cardiac cells, followed by formulating hypotheses on how to reproduce and investigate the hyperinflammatory and pro-thrombotic conditions observed in the heart of COVID-19 patients using experimental in vitro systems. Finally, we elaborate on strategies to discover novel pathology biomarkers using omics platforms.

Original languageEnglish
JournalCardiovascular Research
ISSN0008-6363
DOIs
Publication statusE-pub ahead of print - 12 Jun 2021

Bibliographical note

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions please email: journals.permissions@oup.com.

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