COVID-19 Pandemic and Cardiovascular Diseases: Lessons and Prospects

ISSN 1019-3316, Herald of the Russian Academy of Sciences, 2022, Vol. 92, No. 4, pp. 425–429. © Pleiades Publishing, Ltd., 2022. Russian Text © The Author(s), 2022, published in Vestnik Rossiiskoi Akademii Nauk, 2022, Vol. 92, No. 7, pp. 686–690. Scientific Session of the General Meeting of the RAS Members “The Role of Science in Overcoming Pandemics and Postcrisis Development of Society” COVID-19 Pandemic and Cardiovascular Diseases: Lessons and Prospects E. V. Shlyakhtoа,*, A. O. Konradiа,**, T. L. Karonovaа,***, and P. A. Fedotovа,****,# а Almazov National Medical Research Center, Ministry of Health of Russia, St. Petersburg, Russia *e-mail: **e-mail: ***e-mail: ****e-mail: Received February 11, 2022; revised February 18, 2022; accepted March 28, 2022 Abstract⎯This article is focused on the topicality of assessing complications and mortality from diseases of the circulatory system during the COVID-19 pandemic. The main variants of damage to the cardiovascular system, the mechanisms of their development, and risk factors are given. The long-term consequences of the new coronavirus infection for the heart and blood vessels are considered. In addition, the necessary measures to reduce the burden of disease after the pandemic are discussed. Keywords: coronavirus infection, circulatory system diseases, myocarditis, chronic heart failure, heart transplantation DOI: 10.1134/S1019331622040098 Relationship between coronavirus infection and diseases of the circulatory system: The role of various factors. The COVID-19 pandemic, in addition to complications and deaths directly related to the infection, has significantly affected the system of care for cardiovascular diseases throughout the world and has led to an increase in mortality from diseases of the circulatory system [1]. This close relationship between infection and cardiovascular pathology is due to a number of factors. In the first place, there is direct damage to the cardiovascular system caused by the virus, which can be manifested by myocarditis, the first manifestations of heart failure, rhythm disturbances, and other symptoms. Coronavirus infection in the acute period is often complicated by arterial and venous thrombosis, leading to fatal outcomes, and can also debut with myocardial infarction and stroke, which creates addi# RAS Academician Evgenii Vladimirovich Shlyakhto is Director General of the Almazov National Medical Research Center of the Ministry of Health of Russia. RAS Academician Aleksandra Olegovna Konradi is Deputy Director General for Science of the same сenter. Tat’yana Leonidovna Karonova, Dr. Sci. (Med.), is Chief Researcher and Head of the Clinical Endocrinology Laboratory at the Institute of Endocrinology under the above center. Petr Alekseevich Fedotov, Cand. Sci. (Med.), is Head of the Laboratory of Hi-Tech Methods at the Institute of the Heart and Vessels under the same center. tional difficulties in patient routing and timely diagnosis. In addition, the infection can lead to a number of complications (they are combined into the so-called post-COVID syndrome), manifesting itself in an increased long-term tendency to thrombosis; aggravation of the course of previous diseases, including arterial hypertension and chronic heart failure; and the development of pulmonary hypertension in patients with pulmonary fibrosis. A certain role in heart damage can be played by the toxicity of antiviral drugs, particularly those affecting the duration of the QT interval, which was noted in the first wave of coronavirus infection, when these groups of drugs were widely used in treatment. According to the Almazov National Medical Research Center, among the 1412 patients who received hydroxychloroquine therapy in compliance with version 2 of the Interim Methodological Recommendations of the Russian Ministry of Health for the diagnosis and treatment of coronavirus infection [2], 14% experienced an increase in the QT interval to more than 500 ms, or more than 60 ms from the original. The epidemic has had a very significant impact on the rates of mortality from diseases of the circulatory system because of the adjustments made to the process of organizing medical care. This is due not only and not so much to the shortage of beds and medical personnel as to changes in the behavior of the patients 425 426 SHLYAKHTO et al. themselves, fear of infection and hospitals, and seeking medical help late [3]. In the context of the conversion of many hospitals to treat patients with coronavirus infection, the number of heart attacks and strokes did not increase during the epidemic and even decreased in many regions of the country. Most likely, this indicates that patients with mild symptoms did not consult a doctor in a timely manner (data from the Federal State Statistics Service (Rosstat) and monitoring of the decline in mortality from coronary heart disease conducted by the Russian Ministry of Health). In the long term, this problem may lead to an increase in the number of patients with chronic heart failure because of untimely emergency care or its absence in acute coronary pathology. Of course, the high burden on health care in all countries could not but affect the availability of medical care. At present, these drawbacks have partially been overcome thanks to telemedicine technologies and remote monitoring. However, the introduction of such services took time and required significant investments and training of staff and patients. In Russia, in addition to the official register of patients with the new coronavirus infection, public associations and research centers have organized specialized registers, within the framework of which data were obtained on the prevalence of cardiovascular diseases as a comorbidity and on the prognosis of treatment for patients with coronavirus infection depending on the presence of diseases of the vascular system and complications. Thus, data from the ACTIV register have already been published, clearly demonstrating a relationship between cardiovascular pathology and mortality from coronavirus infection [4]. They are quite consistent with the data of the first study in China, in which diseases of the circulatory system were identified as the leading risk factors for severe and fatal COVID-19 [5]. In the ACTIV register, it was found that in the presence of arterial hypertension, the odds ratio for death was more than 3.0, and in the presence of chronic heart failure of functional classes III‒IV, more than 6.0 [4]. Similar data were obtained in the registry of the Russian Society of Cardiology, according to which chronic heart failure was the most significant predictor of a poor prognosis not only immediate but also long-term [6], accounting for 55% of more than 100 cardiovascular complications of coronavirus infection and significantly surpassing rhythm disturbances (15.9%), acute coronary syndrome (9.9%), and myocarditis (7.9%) in terms of the registration frequency. More (...truncated)