1.2 COVID-19 in the cardiovascular system
Because COVID-19 may affect the cardiovascular system at multiple
levels, the virus infection may lead to myocardial damage and
dysfunction, increasing the incidence of CVD in patients. The mechanism
of COVID-19-induced heart damage was unclear, but it may involve the
combined effects of direct viral damage, immune damage, and cytotoxic
immune cell responses in the later stages of the infection [5].
Cardiac involvement was a documented complication of COVID-19 and was
associated with a higher hospital mortality rate [6]. In a study on
the impact of CVD complications on death outcomes, 35.3% of 187
enrolled patients had potential CVD. Moreover, the presence of
myocardial injury was significantly related to the mortality rate among
COVID-19 patients, and the prognosis was better in patients without
myocardial injury [7]. In a patient with acute heart injury directly
related to SARS-CoV-2 localized in the myocardium, a biopsy of
myocardial intima documented low-grade myocardial inflammation, but no
viral particles in myocardial cells were found [8]. Therefore, the
onset and progression of COVID-19 may cause myocardial damage
independently of the infection of the cardiac tissue by the virus.
Although the specific mechanism remained unknown, it would be still
necessary to pay attention to the protection of the cardiovascular
system in COVID-19 patients during the treatment of the disease.