Fisiopatologia da insuficiência cardíaca em pacientes com COVID-19
Palavras-chave:
pandemia, COVID-19, SARS-CoV-2, dano miocárdico, inflamação, citocinas, insuficiência cardíacaResumo
Introdução: revelam-se controvérsias a respeito dos mecanismos que determinam a vulnerabilidade dos pacientes com insuficiência cardíaca à infecção pelo vírus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), gerador da síndrome respiratória denominada Coronavirus Infectious Disease-19 (COVID-19).
Objetivo: coletar informações sobre a fisiopatologia da insuficiência cardíaca aguda no contexto da COVID-19.
Método: na Policlínica Comunitária "Ramón López Peña" de Santiago de Cuba, entre setembro e novembro de 2020, foi realizada uma revisão narrativa sobre o tema. A busca foi realizada por meio de consulta às bases de dados Pubmed, Infomed e SciELO, sem restrição de datas, nos idiomas espanhol e inglês.
Desenvolvimento: a incerteza se manifesta nos mecanismos envolvidos na fisiopatologia da insuficiência cardíaca em pacientes com essa doença infecciosa. O dano miocárdico se deve aos efeitos diretos da infecção viral no miócito, que se expressa como resposta inflamatória local, e ao envolvimento do coração como órgão alvo da resposta inflamatória sistêmica e inadequada gerada pela liberação acentuada de citocinas. Esta última também gera dano endotelial que desencadeia complicações tromboembólicas e isquêmicas, disfunção cardíaca sistodiastólica e, finalmente, falência de múltiplos órgãos.
Conclusões: apesar dos avanços no conhecimento da etiopatogenia desta doença, ainda é necessário esclarecer com precisão os mecanismos fisiopatológicos que determinam a apresentação da insuficiência cardíaca, embora se reconheça a influência da resposta inflamatória inadequada, induzida por citocinas, na apresentação de dano miocárdico.
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Referências
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16.Rozadoa J, Ayestaa A, Morísa C, Avanzas A. Fisiopatología de la enfermedad cardiovascular en pacientes con COVID-19. Isquemia, trombosis y disfunción cardiac. Rev Esp Cardiol [Internet]. 2020 [citado 23 Nov 2020]; 20(SE):2-8. Disponible en: https://www.revespcardiol.org/es-fisiopatologia-enfermedad-cardiovascular-pacientes-con-articulo-S1131358720300285
17.Vaduganathan M, Vardeny O, Michel T, McMurray J, Pfeffer MA, Solomon SD. Renin-angiotensin-aldosterone system inhibitors in patients with COVID-19. N Engl J Med [Internet]. 2020 [citado 5 Dic 2020]; 382:1653-1659. DOI: http://dx.doi.org/10.1056/NEJMsr2005760
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20.Qin C, Zhou L, Hu Z. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect [Internet]. 2020 [citado 11 Dic 2020]; 71(15):762-768. DOI: http://dx.doi.org/10.1093/cid/ciaa248
21.Jamal FA, Khaled SK. The cardiovascular complications of chimeric antigen receptor T cell therapy. Curr Hematol Malig Rep [Internet]. 2020 [citado 12 Dic 2020]; 15:130-132. DOI: http://dx.doi.org/10.1007/s11899-020-00567-4
22.Chen J, Lau YF, Lamirande EW. Cellular immune responses to severe acute respiratory syndrome coronavirus (SARS-CoV) infection in senescent BALB/c mice: CD4+ T cells are important in control of SARS-CoV infection. Virol [Internet]. 2020 [citado 12 Dic 2020]; 84:1289-1301 DOI: http://dx.doi.org/10.1128/JVI.01281-09
23.ACC. Chinese clinical guidance for COVID-19 pneumonia diagnosis and treatment. Am Coll Cardiol [Internet]. 2020 [citado 12 Dic 2020]; 27:1451-1454. Disponible en: http://kjfy.meetingchina.org/msite/news/show/%20cn/3337.html.%20Consultado%20Jul%202020
24.Shi Y, Wang Y, Shao C. COVID-19 infection: the perspectives on immune responses. Cell Death Differ [Internet]. 2020 [citado 12 Dic 2020]; 27:1451-1454. DOI: http://dx.doi.org/10.1038/s41418-020-0530-3
25.Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intens Care Med [Internet]. 2020 [citado 15 Dic 2020]; 46(5):846-848. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32125452/
26.Ferrante G, Condorelli G. Interleukin-6 trans-signalling and risk of future cardiovascular events: a new avenue for atheroprotection? Cardiovasc Res [Internet]. 2020 [citado 11 Dic 2020]; 115(1):8-9. DOI: http://dx.doi.org/10.1093/cvr/cvy233
27.Oudit GY, Kassiri Z, Jiang C. SARS-coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. Eur J Clin Invest [Internet]. 2009 [citado 14 Dic 2020]; 39(7):618-25. DOI: http://dx.doi.org/10.1111/j.1365-2362.2009.02153.x
28.Brauner S, Jiang X, Thorlacius GE. Augmented Th17 differentiation in Trim21 deficiency promotes a stable phenotype of atherosclerotic plaques with high collagen content. Cardiovasc Res [Internet]. 2018 [citado 14 Dic 2020]; 114(1):158-167. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29016728/
29.Chou CH, Hung CS, Liao CW. IL-6 trans-signalling contributes to aldosterone-induced cardiac fibrosis. Cardiovasc Res [Internet]. 2018 [citado 13 Dic 2020]; 114(5):690-702. DOI: http://dx.doi.org/10.1093/cvr/cvy013
30.Tamura Y, Phan C, Tu L. Ectopic upregulation of membrane-bound IL6R drives vascular remodeling in pulmonary arterial hypertension. J Clin Inv [Internet]. 2018 [citado 13 Dic 2020]; 128(5):1956-1970. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29629897/
2. Accelerate Change Together Heart Failure Gap Review AstraZeneca and World Heart Federation. https://www.world-heart-federation.org. 2020 [citado 15 Dic 2020] Disponible en: https://www.world-heart-federation.org/resources/accelerate-change-together-heart-failure-gap-review/
3. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA [Internet]. 2020 [citado 15 Dic 2020]; 323(11):1061-1069. DOI: https://doi.org/10.1001/jama.2020.1585
4. Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med [Internet]. 2020 [citado 15 Dic 2020]; 382(18):1708-1720. Disponible en https://pubmed.ncbi.nlm.nih.gov/32109013/
5. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Resp Med [Internet]. 2020 [citado 15 Dic 2020]; 8(5):475-81. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32105632/
6. Veli H, Wilfried M, Marek B, Johann B, Hans-Peter B, Ovidiu Ch. Organ dysfunction, injury and failure in acute heart failure. A review on behalf of the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). European J Heart Failure [Internet]. 2017 [citado 15 Dic 2020]; 19(7):821–836. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.872#:~:text=Organ%20injury%20and%20impairment%20are%20commonly%20observed%20in,proportion%20presents%20with%20peripheral%20hypoperfusion%20or%20cardiogenic%20shock
7. Guo T, Fan Y, Chen M, Xu X, Zhang L, He T, et al. Cardiovascular implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Card [Internet]. 2020 [citado 15 Dic 2020]; 5(7):811-18. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32219356/
8. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med [Internet]. 2020 [citado 15 Dic 2020]; 382(8):727-33. Disponible en: https://www.nejm.org/doi/full/10.1056/NEJMoa2001017
9. Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Card [Internet]. 2020 [citado 15 Dic 2020]; 5(7):802-10. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32211816/
10.Zhou F, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Clinical course and risk factors for mortality of adult inpatients with COVID19 in Wuhan, China: a retrospective cohort study. Lancet [Internet]. 2020 [citado 15 Dic 2020]; 395(10229):1054-1062. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext
11.Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet [Internet]. 2020 [citado 15 Dic 2020]; 395(10223). Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30183-5/fulltext
12.Kobayashi T, Jung SM, Linton NM, Kinoshita R, Hayashi K, Miyama T. Communicating the Risk of Death from Novel Coronavirus Disease (COVID-19). J Clin Med [Internet]. 2020 [citado 15 Dic 2020]; 9(2). Disponible en: https://www.mdpi.com/2077-0383/9/2/580/htm
13.Elias R, Elias KS, González F, Maceo E. Influencia de la COVID-19 sobre el sistema cardiovascular. Gac Méd Estud [Internet]. 2020 [citado 22 Dic 2020]; 1(2):12. Disponible en: http://www.revgacetaestudiantil.sld.cu/index.php/gme/article/view/36
14.Sellén E, Sellén J, Sellén L. Daño miocárdico en la infección por SARS-CoV-2. Rev Finlay [Internet]. 2020 [citado 27 Dic 2020]; 10(4):[aproximadamente 6 p.]. Disponible en: http://www.revfinlay.sld.cu/index.php/finlay/article/view/870
15.Henry C, Zaizafoun M, Stock E, Ghamande S, Arroliga AC, White HD. Impact of angiotensin converting enzyme inhibitors and statins on viral pneumonia. Proc (Bay l Univ Med Cent). 2018 [citado 23 Nov 2020]; 31(4):419-23. Disponible en: https://pubmed.ncbi.nlm.nih.gov/30948970/
16.Rozadoa J, Ayestaa A, Morísa C, Avanzas A. Fisiopatología de la enfermedad cardiovascular en pacientes con COVID-19. Isquemia, trombosis y disfunción cardiac. Rev Esp Cardiol [Internet]. 2020 [citado 23 Nov 2020]; 20(SE):2-8. Disponible en: https://www.revespcardiol.org/es-fisiopatologia-enfermedad-cardiovascular-pacientes-con-articulo-S1131358720300285
17.Vaduganathan M, Vardeny O, Michel T, McMurray J, Pfeffer MA, Solomon SD. Renin-angiotensin-aldosterone system inhibitors in patients with COVID-19. N Engl J Med [Internet]. 2020 [citado 5 Dic 2020]; 382:1653-1659. DOI: http://dx.doi.org/10.1056/NEJMsr2005760
18.Yao XH, Li TY, He ZC. A pathological report of three COVID-19 cases by minimal invasive autopsies. Zhonghua Bing Li Xue Za Zhi [Internet]. 2020 [citado 19 Nov 2020] 49:411-417. DOI: http://dx.doi.org/10.3760/cma.j.cn112151-20200312-00193
19.Obregón ÁG, Adolfo J, Pérez A, Vila EE. Insuficiencia cardíaca aguda en época de COVID-19. Rev Cubana Cardiol Cir Cardiovasc [Internet]. 2020 [citado 19 Nov 2020]; 26(2):[aproximadamente 11 p.]. Disponible en: http://revcardiologia.sld.cu/index.php/revcardiologia/article/view/995
20.Qin C, Zhou L, Hu Z. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect [Internet]. 2020 [citado 11 Dic 2020]; 71(15):762-768. DOI: http://dx.doi.org/10.1093/cid/ciaa248
21.Jamal FA, Khaled SK. The cardiovascular complications of chimeric antigen receptor T cell therapy. Curr Hematol Malig Rep [Internet]. 2020 [citado 12 Dic 2020]; 15:130-132. DOI: http://dx.doi.org/10.1007/s11899-020-00567-4
22.Chen J, Lau YF, Lamirande EW. Cellular immune responses to severe acute respiratory syndrome coronavirus (SARS-CoV) infection in senescent BALB/c mice: CD4+ T cells are important in control of SARS-CoV infection. Virol [Internet]. 2020 [citado 12 Dic 2020]; 84:1289-1301 DOI: http://dx.doi.org/10.1128/JVI.01281-09
23.ACC. Chinese clinical guidance for COVID-19 pneumonia diagnosis and treatment. Am Coll Cardiol [Internet]. 2020 [citado 12 Dic 2020]; 27:1451-1454. Disponible en: http://kjfy.meetingchina.org/msite/news/show/%20cn/3337.html.%20Consultado%20Jul%202020
24.Shi Y, Wang Y, Shao C. COVID-19 infection: the perspectives on immune responses. Cell Death Differ [Internet]. 2020 [citado 12 Dic 2020]; 27:1451-1454. DOI: http://dx.doi.org/10.1038/s41418-020-0530-3
25.Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intens Care Med [Internet]. 2020 [citado 15 Dic 2020]; 46(5):846-848. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32125452/
26.Ferrante G, Condorelli G. Interleukin-6 trans-signalling and risk of future cardiovascular events: a new avenue for atheroprotection? Cardiovasc Res [Internet]. 2020 [citado 11 Dic 2020]; 115(1):8-9. DOI: http://dx.doi.org/10.1093/cvr/cvy233
27.Oudit GY, Kassiri Z, Jiang C. SARS-coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. Eur J Clin Invest [Internet]. 2009 [citado 14 Dic 2020]; 39(7):618-25. DOI: http://dx.doi.org/10.1111/j.1365-2362.2009.02153.x
28.Brauner S, Jiang X, Thorlacius GE. Augmented Th17 differentiation in Trim21 deficiency promotes a stable phenotype of atherosclerotic plaques with high collagen content. Cardiovasc Res [Internet]. 2018 [citado 14 Dic 2020]; 114(1):158-167. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29016728/
29.Chou CH, Hung CS, Liao CW. IL-6 trans-signalling contributes to aldosterone-induced cardiac fibrosis. Cardiovasc Res [Internet]. 2018 [citado 13 Dic 2020]; 114(5):690-702. DOI: http://dx.doi.org/10.1093/cvr/cvy013
30.Tamura Y, Phan C, Tu L. Ectopic upregulation of membrane-bound IL6R drives vascular remodeling in pulmonary arterial hypertension. J Clin Inv [Internet]. 2018 [citado 13 Dic 2020]; 128(5):1956-1970. Disponible en: https://pubmed.ncbi.nlm.nih.gov/29629897/
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2021-06-01
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Hierrezuelo-Rojas N, Subert-Salas L, Fernández-González P, Carbó-Cisnero Y. Fisiopatologia da insuficiência cardíaca em pacientes com COVID-19. Rev Inf Cient [Internet]. 1º de junho de 2021 [citado 4º de abril de 2025];100(3):e3327. Disponível em: https://revinfcientifica.sld.cu/index.php/ric/article/view/3327
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