- MeSH
- Angina Pectoris diagnosis pathology therapy MeSH
- Chest Pain diagnosis etiology pathology MeSH
- Diagnosis, Differential MeSH
- Myocardial Infarction diagnosis classification pathology therapy MeSH
- Cardiovascular Agents administration & dosage classification MeSH
- Humans MeSH
- Heart Diseases * diagnostic imaging classification pathology therapy MeSH
- Pulmonary Embolism diagnostic imaging pathology therapy MeSH
- Hypertension, Pulmonary diagnosis etiology therapy MeSH
- Prognosis MeSH
- Arrhythmias, Cardiac diagnostic imaging classification physiopathology therapy MeSH
- Cardiac Tamponade diagnostic imaging etiology physiopathology therapy MeSH
- Takotsubo Cardiomyopathy diagnosis etiology pathology therapy MeSH
- Troponin MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Onemocnění koronavirem (coronavirus disease-19, onemocnění COVID-19) významně postihuje celý kardio- vaskulární systém. Charakteristickými znaky závažného infekčního onemocnění COVID-19 jsou poškození mikrovaskulatury, dysfunkce endotelu a trombóza buď jako důsledek virové infekce, nebo nepřímo souvi- sející s intenzivními systémovými a imunitními odpověďmi. Již dříve přítomné kardiovaskulární onemocnění a virová nálož jsou spojeny s poškozením myokardu a nepříznivějším výsledkem léčby. Odpověď cévního systému na tvorbu cytokinů a interakce mezi závažným akutním respiračním syndromem vyvolaným ko- ronavirem-2 (severe acute respiratory syndrome coronavirus-2, SARS-CoV-2) a receptory pro angiotenzin konvertující enzym 2 mohou vést k významnému zhoršení kontraktility srdečního svalu a následné dysfunkci myokardu. Navíc se značné procento pacientů infikovaných virem SARS-CoV-2 plně nezotaví a nadále vyka- zuje dlouhou řadu symptomů, a i po akutní fázi onemocnění se potýká s komplikacemi, i když virová infekce již zdánlivě ustoupila. Tyto stavy, pro které se často používá termín „postcovidový syndrom“ (post-acute COVID-19), mohou mít řadu příčin. K tomuto přispívají rezervoáry viru nebo stále ještě přítomné fragmenty RNA či proteinů viru. Systémová zánětlivá odpověď na onemocnění COVID-19 může zintenzivnit fi brotizaci myokardu, která zase může zpomalovat remodelaci myokardu. V tomto dokumentu shrnujeme současné poznatky o poškození kardiovaskulárního systému a dozvucích onemocnění COVID-19 po jeho akutní fázi. S pokračováním pandemie a objevováním se nových variant viru můžeme rozšířit naše poznatky o základ- ních mechanismech pouze propojením našich znalostí z oblasti patofyziologie s příslušnými klinickými zjiš- těními. Zásadní význam mají identifikace nových biomarkerů kardiovaskulárních komplikací a vývoj nových účinných způsobů léčby infekčního onemocnění COVID-19.
The cardiovascular system is significantly affected in coronavirus disease-19 (COVID-19). Microvascular injury, endothelial dysfunction, and thrombosis resulting from viral infection or indirectly related to the intense systemic inflammatory and immune responses are characteristic features of severe COVID-19. Pre-existing cardiovascular disease and viral load are linked to myocardial injury and worse outcomes. The vascular re- sponse to cytokine production and the interaction between severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and angiotensin-converting enzyme 2 receptor may lead to a signifi cant reduction in cardiac contractility and subsequent myocardial dysfunction. In addition, a considerable proportion of patients who have been infected with SARS-CoV-2 do not fully recover and continue to experience a large number of symptoms and post-acute complications in the absence of a detectable viral infection. These conditions often referred to as ‘post-acute COVID-19’ may have multiple causes. Viral reservoirs or lingering fragments of viral RNA or proteins contribute to the condition. Systemic infl ammatory response to COVID-19 has the potential to increase myocardial fibrosis which in turn may impair cardiac remodelling. Here, we summarize the current knowledge of cardiovascular injury and post-acute sequelae of COVID-19. As the pandemic con- tinues and new variants emerge, we can advance our knowledge of the underlying mechanisms only by in- tegrating our understanding of the pathophysiology with the corresponding clinical findings. Identification of new biomarkers of cardiovascular complications, and development of effective treatments for COVID-19 infection are of crucial importance.
- Keywords
- postcovidový syndrom, protrombotický stav, buněčná léčba,
- MeSH
- Angiotensin-Converting Enzyme 2 MeSH
- Antiviral Agents classification therapeutic use MeSH
- COVID-19 * complications mortality physiopathology pathology MeSH
- Cytokines adverse effects MeSH
- Diabetes Mellitus mortality physiopathology MeSH
- Endothelium physiopathology MeSH
- COVID-19 Drug Treatment MeSH
- Heparin, Low-Molecular-Weight pharmacology therapeutic use MeSH
- Adrenal Cortex Hormones therapeutic use MeSH
- Hypertension etiology complications MeSH
- Myocardial Infarction classification complications physiopathology MeSH
- Cardiovascular Diseases * classification complications physiopathology pathology MeSH
- Cardiovascular System physiopathology pathology MeSH
- Clinical Studies as Topic MeSH
- Comorbidity MeSH
- Diabetes Complications MeSH
- Smoking adverse effects MeSH
- Humans MeSH
- Antibodies, Monoclonal therapeutic use MeSH
- Myocarditis complications MeSH
- Obesity complications physiopathology pathology MeSH
- Sex Characteristics MeSH
- Prognosis MeSH
- Renin-Angiotensin System MeSH
- Risk Factors MeSH
- SARS-CoV-2 pathogenicity MeSH
- Sex Factors MeSH
- Practice Guidelines as Topic MeSH
- Arrhythmias, Cardiac epidemiology complications MeSH
- Heart Failure epidemiology complications MeSH
- Heart Arrest etiology MeSH
- Statistics as Topic MeSH
- Thromboembolism epidemiology complications MeSH
- Thromboinflammation complications physiopathology MeSH
- Inflammation complications physiopathology MeSH
- Check Tag
- Humans MeSH
Right ventricular involvement (RVMI) is a relatively frequent complication in patients developing ST-elevation acute myocardial infarction. The initial diagnosis is most often established using electrocardiography or echocardiography. The gold standard among imaging techniques is cardiac magnetic resonance, which allows to distinguish between reversible and irreversible myocardial damage. The key treatment strategy is emergent revascularization by primary percutaneous coronary intervention whereas patients with hypotension and cardiogenic shock due to the RVMI require fluid replacement and catecholamine therapy. In cases where the shock state progresses despite an adequate management, short- or, possibly, long-term mechanical assist device should be implanted either percutaneously or surgically. Despite appreciable advances in the diagnosis and management, RVMI remains an independent predictor of early as well as late complications (Fig. 6, Ref. 62).
- MeSH
- Echocardiography methods MeSH
- Electrocardiography methods MeSH
- ST Elevation Myocardial Infarction diagnostic imaging diagnosis etiology pathology MeSH
- Myocardial Infarction * diagnostic imaging diagnosis etiology classification pathology MeSH
- Percutaneous Coronary Intervention * methods MeSH
- Humans MeSH
- Heart Ventricles pathology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
- Keywords
- elektrická aktivita srdeční, sinusový rytmus,
- MeSH
- Atrioventricular Block diagnosis classification pathology MeSH
- Bundle-Branch Block diagnosis classification pathology MeSH
- Electrocardiography * methods MeSH
- Cardiac Complexes, Premature diagnosis pathology MeSH
- Atrial Flutter diagnosis classification pathology MeSH
- Cardiomyopathy, Hypertrophic diagnosis classification pathology MeSH
- Myocardial Infarction diagnosis classification pathology MeSH
- Tachycardia, Ventricular diagnosis classification pathology MeSH
- Humans MeSH
- Heart Diseases diagnosis classification pathology MeSH
- Arrhythmias, Cardiac diagnosis classification physiopathology MeSH
- Heart Block diagnosis classification pathology MeSH
- Heart Rate MeSH
- Tachycardia, Supraventricular diagnosis classification pathology MeSH
- Tachycardia diagnosis classification pathology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
PURPOSE: The COMBO biodegradable polymer sirolimus-eluting stent includes endothelial progenitor cell capture (EPC) technology for rapid endothelialization, which may offer advantage in acute coronary syndromes (ACS). We sought to analyze the performance of the COMBO stent by ACS status and ACS subtype. METHODS: The COMBO collaboration (n = 3614) is a patient-level pooled dataset from the MASCOT and REMEDEE registries. We evaluated outcomes by ACS status, and ACS subtype in patients with ST segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) versus unstable angina (UA). The primary endpoint was 1-year target lesion failure (TLF), composite of cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization. Secondary outcomes included stent thrombosis (ST). RESULTS: We compared 1965 (54%) ACS and 1649 (46.0%) non-ACS patients. ACS presentations included 40% (n = 789) STEMI, 31% (n = 600) NSTEMI, and 29% (n = 576) UA patients. Risk of 1-year TLF was greater in ACS patients (4.5% vs. 3.3%, HR 1.51 95% CI 1.01-2.25, p = 0.045) without significant differences in definite/probable ST (1.1% vs 0.5%, HR 2.40, 95% CI 0.91-6.31, p = 0.08). One-year TLF was similar in STEMI, NSTEMI, and UA (4.8% vs 4.8% vs. 3.7%, p = 0.60), but definite/probable ST was higher in STEMI patients (1.9% vs 0.5% vs 0.7%, p = 0.03). Adjusted outcomes were not different in MI versus UA patients. CONCLUSIONS: Despite the novel EPC capture technology, COMBO stent PCI was associated with somewhat greater risk of 1-year TLF in ACS than in non-ACS patients, without significant differences in stent thrombosis. No differences were observed in 1-year TLF among ACS subtypes.
- MeSH
- Acute Coronary Syndrome classification complications mortality surgery MeSH
- Time Factors MeSH
- Endothelial Progenitor Cells metabolism MeSH
- Myocardial Infarction classification complications MeSH
- Percutaneous Coronary Intervention methods MeSH
- Coronary Thrombosis epidemiology MeSH
- Humans MeSH
- Angina, Unstable complications MeSH
- Prosthesis Design MeSH
- Risk Factors MeSH
- Sirolimus administration & dosage MeSH
- Drug-Eluting Stents adverse effects statistics & numerical data MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- MeSH
- Biomarkers * analysis MeSH
- Myocardial Infarction diagnosis etiology classification MeSH
- Cardiomyopathies diagnosis etiology MeSH
- Clinical Laboratory Techniques methods MeSH
- Humans MeSH
- Natriuretic Peptides analysis MeSH
- Heart Diseases * diagnosis etiology MeSH
- Troponin analysis MeSH
- Check Tag
- Humans MeSH
