A modern pathogenetic concept for developing diagnostic criteria for cardiac injury in patients after COVID-19 infection
The COVID-19 pandemic was accompanied not only by the development of acute respiratory pathology but also by an increase in the incidence of delayed cardiovascular complications, indicating the presence of complex pathogenetic interactions in the virus-host system. The multisystem nature of the disease, driven by several key mechanisms, has now been established. The first is related to the virus’s tropism for tissues expressing the angiotensin-converting enzyme 2 receptor, leading to an imbalance in the renin-angiotensin system (RAAS) with predominant proinflammatory, vasoconstrictor, and prothrombotic effects. The second is the ability of SARS-CoV-2, which has a tropism for cardiac tissue, to initiate a signaling cascade of cardiomyocyte necroptosis. The third mechanism is mediated by virus-induced hypomethylation of the promoter regions of genes encoding proinflammatory cytokines, which contributes to the development of chronic systemic inflammation and damage to the vascular endothelium.Ageikin A.V., Gorelov A.V., Usenko D.V., Rybalkin S.B., Kurmaeva D.Yu., Bogonina V.E., Davydova R.R.
Conclusion. To identify the leading pathogenetic mechanism, promptly predict the risk of cardiovascular complications, and determine patient management strategies, it is necessary to develop and implement a strategy for the qualitative and quantitative assessment of specific biological markers into clinical practice. Their implementation will reduce disability and mortality rates among individuals who have recovered from COVID-19.
Keywords
COVID-19
SARS-CoV-2
post-COVID syndrome/Long-COVID
PASC (Post-Acute Sequelae of SARS-CoV-2)
RAAS dysregulation
necroptosis
cytokine storm
cellular reprogramming
biomarkers
troponin
myoglobin
D-dimer
ferritin
C-reactive protein
IL-6
TNF-α
cardiovascular complications in COVID-19
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About the Authors
Alexey V. Ageikin, Cand. Med. Sci., Associate Professor, Department of Infectious Diseases, Medical Institute, Penza State University, Penza, Russia; ageykinav@yandex.ru; http://orcid.org/0000-0001-5092-4744Professor Alexander V. Gorelov, Academician of the Russian Academy of Sciences, MD, Deputy Director for Research, Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia; agorelov_05@mail.ru; http://orcid.org/0000-0001-9257-0171
Denis V. Usenko, MD, Associate Professor, Department of Infectious Diseases, Medical Institute, Penza State University, Penza, Russia; Leading Researcher, Clinical Department of Infectious Pathology, Central Research Institute of Epidemiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Moscow, Russia; dusenko@rambler.ru; https://orcid.org/0000-0001-5232-7337
Sergey B. Rybalkin, Honored Doctor of the Russian Federation, Cand. Med. Sci., Associate Professor, Department of Infectious Diseases, Medical Institute, Penza State University, Penza, Russia; svmp@penzadom.ru; https://orcid.org/0000-0002-2933-5758
Dzhamilya Yu. Kurmaeva, Cand. Med. Sci., Associate Professor, Department of Infectious Diseases, Medical Institute, Penza State University, Penza, Russia; d.kurmaeva@yandex; https://orcid.org/0000-0001-7989-7647
Veronika E. Bogonina, 5th-year student, Faculty of Medicine, Pediatrics specialty, Medical Institute, Penza State University, Penza, Russia; bogoninaveronika@yandex.ru, https://orcid.org/0009-0004-2518-4034
Ramziya R. Davydova, 5th-year student, Faculty of Medicine, Pediatrics specialty, Medical Institute, Penza State University, Penza, Russia; davydova03rr@list.ru, https://orcid.org/0009-0003-8919-7136
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