© 1921—2024 Учреждение образования «Белорусский государственный медицинский университет».
Контент доступен под лицензией Creative Commons
Attribution 4.0 License.
Адрес для писем
220006, г. Минск, ул. Ленинградская, 6, кабинет 2.
Телефон: 8 (017) 328-58-92
E-mail: emcardio@bsmu.by
2023 том 7, №1
Фундаментальные исследования

Острое повреждение миокарда у пациентов с COVID-19: патогенетические аспекты, вопросы дифференциальной диагностики

А.А. Плешко, Е.Б. Петрова, Е.А. Григоренко, Т.В. Горбат, С.В. Гунич, Н.П. Митьковская
Белорусский государственный медицинский университет, г. Минск, Беларусь, ГУ «РНПЦ «Кардиология», г. Минск, Беларусь, УЗ «4-я городская клиническая больница им. Н.Е. Савченко», г. Минск, Беларусь
В свете пандемии COVID-19, вызванной вирусом SARS-CoV-2, сердечно-сосудистые осложнения становятся медико-социальной проблемой, значимость которой в постковидном периоде увеличивается. Сердечно-сосудистые события на фоне COVID-19 включают в себя острое ишемическое и неишемическое повреждение миокарда – до 21%, острую сердечную недостаточность, нарушения ритма и проводимости (до 15%), венозные (до 7% у пациентов в терапевтическом отделении и до 22% в отделении интенсивной терапии) и артериальные тромботические осложнения (до 11%). Проведен ретроспективный анализ медицинских карт 10 908 стационарных пациентов в возрасте от 18 до 90 лет, находившихся на лечении с 01 июня 2020 г. по 31 мая 2021 г. в УЗ «4-я ГКБ им. Н.Е. Савченко». Распространенность миокардиального повреждения, развившегося на фоне SARS-CoV-2, составила 5,28% (n = 576), отмечалось у пациентов различных возрастных групп, в том числе у лиц без предшествующего сердечно-сосудистого анамнеза. В статье представлен анализ актуальных общемировых данных о патогенетических аспектах острого повреждения миокарда у пациентов с COVID-19. Отмечено, что МРТ сердца является эффективным, точным и неинвазивным методом дифференциальной диагностики ишемического и воспалительного повреждения миокарда при COVID-19. Предложен алгоритм дифференциальной диагностики острого повреждения миокарда у данной категории пациентов.
ключевые слова: COVID-19, SARS-CoV-2, острое повреждение миокарда, миокардит, алгоритм, МРТ.

для цитирования: А.А. Плешко, Е.Б. Петрова, Е.А. Григоренко, Т.В. Горбат, С.В. Гунич, Н.П. Митьковская. Острое повреждение миокарда у пациентов с COVID-19: патогенетические аспекты, вопросы дифференциальной диагностики. Неотложная кардиология и кардиоваскулярные риски, 2023, Т. 7, № 1, С. 1859–1867

Acute myocardial injury in COVID-19 patients: pathogenetic aspects and differential diagnosis considerations
A.A. Pleshko, E.B. Petrova, E.A. Grigorenko, T.V. Gorbat, S.V. Gunich, N.P. Mitkovskaya
I n the light of COVID-19 pandemic caused by SARS-CoV-2 virus, cardiovascular complications become a medical and social problem, the significance of which increases in the post-acute phase. Cardiovascular events against COVID-19 include both acute ischemic and non-ischemic myocardial injury – up to 21%, acute heart failure, rhythm and conduction disorders (up to 15%), venous (up to 7% in patients in the general department and up to 22% in the intensive care unit) and arterial thrombotic complications (up to 11%). The retrospective analysis of medical records of 10 908 inpatients aged 18 to 90 years, who were treated from June 01, 2020 to May 31, 2021 in The 4th City Clinical Hospital named after M.J. Saŭčanka was performed. Prevalence of myocardial injury developed against the background of SARS-CoV-2 was 5.28% (n = 576), it was observed in patients of different age groups, including those without previous cardiovascular history. The article presents an analysis of current worldwide data on pathogenetic aspects of acute myocardial injury in patients with COVID-19. It is noted that cardiac MRI is an effective, accurate and noninvasive method of differential diagnosis of ischemic and inflammatory myocardial injury in COVID-19. The algorithm for differential diagnostics of acute myocardial injury in this category of patients is proposed.
keywords: COVID-19, SARS-CoV-2, acute myocardial injury, myocarditis, algorithm, MRI.

for references: A.A. Pleshko, E.B. Petrova, E.A. Grigorenko, T.V. Gorbat, S.V. Gunich, N.P. Mitkovskaya. Acute myocardial injury in COVID-19 patients: pathogenetic aspects and differential diagnosis considerations). Neotlozhnaya kardiologiya i kardiovaskulyarnye riski [Emergency cardiology and cardiovascular risks], 2023, vol. 7, no. 1, pp. 1859–1867.

1. WHO Coronavirus (COVID-19) Dashboard [electronic resource]. Available at: https://covid19.who.int. (accessed: 15.05.2023).
2. Wrigley-Field E., Himmelstern J. Is Covid-19 Mortality “Like the Flu”? A Cumulative Death Rates Comparison. medRxiv, 2023 Apr 26, 2023.04.24. doi: 10.1101/2023.04.24.23289045. Preprint.
3. Rodríguez A., Ruiz-Botella M., Martín-Loeches I., et al. Deploying unsupervised clustering analysis to derive clinical phenotypes and risk factors associated with mortality risk in 2022 critically ill patients with COVID-19 in Spain. Crit Care Lond Engl, 2021, vol. 25(1), pp. 63. doi: 10.1186/s13054-021-03487-8.
4. Raisi-Estabragh Z., Cooper J., Salih A., Raman B., Lee A.M., Neubauer S., Harvey N.C., Petersen S.E. Cardiovascular disease and mortality sequelae of COVID-19 in the UK Biobank. Heart, 2023, vol. 109(2), pp. 119-126. doi: 10.1136/heartjnl-2022-321492.
5. Katsoularis I., Fonseca-Rodríguez O., Farrington P., Lindmark K., Fors Connolly A.-M. Risk of acute myocardial infarction and ischaemic stroke following COVID-19 in Sweden: a self-controlled case series and matched cohort study. Lancet, 2021, vol. 398(10300), pp. 599-607. doi: 10.1016/S0140-6736(21)00896-5.
6. Daugherty S.E., Guo Y., Heath K., Dasmariñas M.C., Jubilo K.G., Samranvedhya J., Lipsitch M., Cohen K. Risk of clinical sequelae after the acute phase of SARS-CoV-2 infection: retrospective cohort study. BMJ, 2021, vol. 373, n1098. doi: 10.1136/bmj.n1098.
7. Aliberti S., Ramirez J.A. Cardiac diseases complicating community-acquired pneumonia. Curr Opin Infect Dis, 2014, vol. 27(3), pp 295-301. doi: 10.1097/QCO.0000000000000055.
8. Corrales-Medina V.F., Serpa J., Rueda A.M., Giordano T.P., et al. Acute Bacterial Pneumonia is Associated With the Occurrence of Acute Coronary Syndromes. Medicine (Baltimore), 2009, vol. 88(3), pp. 154-159. doi: 10.1097/MD.0b013e3181a692f0.
9. Pleshko A., Mitkovskaya N., Grigorenko E., Yushkevich E., Blatun V. Serdechno-sosudistye sobytiya u pacientov s vnebolnichnoj pnevmoniej [Cardiovascular events in patients with community-acquired pneumonia]. Kardiologiya v Belarusi, 2020, vol. 12(4), pp. 578-591. (in Russian).
10. Beyerstedt S., Casaro E.B., Rangel É.B. COVID-19: angiotensin-converting enzyme 2 (ACE2) expression and tissue susceptibility to SARS-CoV-2 infection. Eur J Clin Microbiol Infect Dis, 2021, vol. 40(5), pp. 905-919. doi: 10.1007/s10096-020-04138-6.
11. Potere N., Valeriani E., Candeloro M., et al. Acute complications and mortality in hospitalized patients with coronavirus disease 2019: a systematic review and meta-analysis. Crit Care Lond Engl, 2020, vol. 24(1), pp. 389. doi: 10.1186/s13054-020-03022-1.
12. Reyes L.F., Garcia-Gallo E., Murthy S., et al. Major adverse cardiovascular events (MACE) in patients with severe COVID-19 registered in the ISARIC WHO clinical characterization protocol: A prospective, multinational, observational study. J Crit Care, 2023, vol. 77, pp. 154318. doi: 10.1016/j.jcrc.2023.154318.
13. Pleshko A., Petrova E., Grigorenko E., Mitkovskaya N. Serdechno-sosudistye sobytiya u pacientov s novoj koronavirusnoj infekciej COVID-19 [Cardiovascular events in patients with novel coronavirus infection COVID-19]. Kardiologiya v Belarusi, 2020, vol. 13(4), pp. 580-595. doi: 10.34883/PI.2021.13.4.007. (in Russian).
14. Zhao Y.-H., Zhao L., Yang X.-C., Wang P. Cardiovascular complications of SARS-CoV-2 infection (COVID-19): a systematic review and meta-analysis. Rev Cardiovasc Med, 2021, vol. 22(1), pp. 159. doi: 10.31083/j.rcm.2021.01.238.
15. 15.Ali M.A.M., Spinler S.A. COVID-19 and thrombosis: From bench to bedside. Trends Cardiovasc Med, 2021, vol. 31(3), pp. 143-160. doi: 10.1016/j.tcm.2020.12.004.
16. Nopp S., Moik F., Jilma B., Pabinger I., Ay C. Risk of venous thromboembolism in patients with COVID-19: A systematic review and meta-analysis. Res Pract Thromb Haemost, 2020, vol. 4(7), pp. 1178-1191. doi: 10.1002/rth2.12439.
17. Nematzoda O., Gaibov A.D., Kalmykov E.L., Baratov A.K. COVID-19-associirovannyj arterialnyj tromboz [COVID-19-related arterial thrombosis]. Vestnik Avicenny, 2021, vol. 23(1), pp. 85-94. (in Russian).
18. Wu J., Mamas M.A., Mohamed M.O., Kwok C.S., et al. Place and causes of acute cardiovascular mortality during the COVID19 pandemic: retrospective cohort study of 580,972 deaths in England and Wales, 2014 to 2020. Place and causes of acute cardiovascular mortality during the COVID19 pandemic. Cardiovascular Medicine, 2020.
19. Richardson S., Hirsch J.S., Narasimhan M., et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized with COVID-19 in the New York City Area. JAMA, 2020, vol. 323(20), pp. 2052-2059. doi: 10.1001/jama.2020.6775.
20. Thygesen K., Alpert J.S., Jaffe A.S., et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J, 2019, vol. 40(3), pp. 237-269. doi: 10.1093/eurheartj/ehy462.
21. Crudo V.L., Ahmed A.I., Cowan E.L., Shah D.J., Al-Mallah M.H., Malahfji M. Acute and Subclinical Myocardial Injury in COVID-19. Methodist Debakey Cardiovasc J, 2021, vol. 17(5), pp. 22-30. doi: 10.14797/mdcvj.1038. 22. Shi S., Qin M., Shen B., et al. Association of Cardiac Injury with Mortality in Hospitalized Patients with COVID-19 in Wuhan, China. JAMA Cardiol, 2020, vol. 5(7), pp. 802-810. doi: 10.1001/jamacardio.2020.0950.
23. Karbalai Saleh S., Oraii A., Soleimani A., et al. The association between cardiac injury and outcomes in hospitalized patients with COVID-19. Intern Emerg Med, 2020, vol. 15(8), pp. 1415-1424. doi: 10.1007/s11739-020-02466-1.
24. Giustino G., Croft L.B., Stefanini G.G., et al. Characterization of Myocardial Injury in Patients with COVID-19. J Am Coll Cardiol, 2020, vol. 76(18), pp. 2043-2055. doi: 10.1016/j.jacc.2020.08.069.
25. Sandoval Y., Januzzi J.L., Jaffe A.S. Cardiac Troponin for Assessment of Myocardial Injury in COVID-19. J Am Col Cardiol, 2020, vol. 76(10), pp. 1244-1258. doi: 10.1016/ j.jacc.2020.06.068.
26. Sandoval Y., Smith S.W., Sexter A., Schulz K., Apple F.S. Incidence and Prognostic Impact of Infection in Patients with Type 1 and 2 Myocardial Infarction. Clin Chem, 2020, vol. 66(9), pp. 1240-1241. doi: 10.1093/clinchem/hvaa138.
27. Mitkovskaya N.P., Karpov I.A., Arutyunov G.P., Grigorenko Ye.A., Ruzanov D.Yu., Statkevich T.V., Tarlovskaya E.I. Koronavirusnaya infekciya COVID-19 (obzor mezhdunarodnyh nauchnyh dannyh) [COVID-19 coronavirus infection (overview of international research data)]. Neotlozhnaya Kardiologiya Kardiovaskulyarnye Riski, 2020, vol. 4(1), pp. 784-815. (in Russian).
28. Abate S.M., Mantefardo B., Nega S., et al. Global burden of acute myocardial injury associated with COVID-19: A systematic review, meta-analysis, and meta-regression. Ann Med Surg (Lond), 2021, vol. 68, pp. 102594. doi: 10.1016/ j.amsu.2021.102594.
29. Hendren N.S., Drazner M.H., Bozkurt B., Cooper Jr L.T. Description and Proposed Management of the Acute COVID-19 Cardiovascular Syndrome. Circulation, 2020, vol. 141(23), pp. 1903-1914. doi: 10.1161/CIRCULATIONAHA.120.047349.
30. Del Prete A., Conway F., Della Rocca D.G., et al. COVID-19, Acute Myocardial Injury, and Infarction. Card Electrophysiol Clin, 2022, vol. 14(1), pp. 29-39. doi: 10.1016/ j.ccep.2021.10.004.
31. Dou Q., Wei X., Zhou K., Yang S., Jia P. Cardiovascular Manifestations and Mechanisms in Patients with COVID-19. Trends Endocrinol Metab, 2020, vol. 31(12), pp. 893-904. doi: 10.1016/j.tem.2020.10.001.
32. Diaz-Arocutipa C., Torres-Valencia J., Saucedo-Chinchay J., Cuevas C. ST-segment elevation in patients with COVID-19: a systematic review. J Thromb Thrombolysis, 2021, vol. 52(3), pp. 738-745. doi: 10.1007/s11239-021-02411-9.
33. Stefanini G.G., Montorfano M., Trabattoni D., et al. ST-Elevation Myocar - dial Infarction in Patients with COVID-19: Clinical and Angiographic Outcomes. Circulation, 2020, vol. 141(25), pp. 2113-2116. doi: 10.1161/ CIRCULATIONAHA.120.047525.
34. Zhao Y.-H., Zhao L., Yang X.-C., Wang P. Cardiovascular complications of SARS-CoV-2 infection (COVID-19): a systematic review and meta-analysis. Rev Cardiovasc Med, 2021, vol. 22(1), pp. 159-165. doi: 10.31083/j.rcm.2021.01.238.
35. Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 2015, vol. 386(9995), pp. 743-800. doi: 10.1016/S0140-6736(15)60692-4.
36. Kariyanna P.T., Sutarjono B., Grewal E., et al. A Systematic Review of COVID-19 and Myocarditis. Am J Med Case Rep, 2020, vol. 8(9), pp. 299-305. doi: 10.12691/ajmcr-8-9-11.
37. Amvrosieva T.V., Mitkovskaya N.P., Bohush Z.F., Arinovich A.S., Balysh E.M. Vozbuditeli virusnyh miokarditov [The causative agents of viral myocarditis]. Neotlozhnaya Kardiologiya Kardiovaskulyarnye Riski, 2020, vol. 4(1), pp. 817-823. (in Russian).
38. Roshdy A., Zaher S., Fayed H., Coghlan J.G. COVID-19 and the Heart: A Systematic Review of Cardiac Autopsies. Front Cardiovasc Med, 2021, vol. 7, pp. 626975. doi: 10.3389/fcvm.2020.626975.
39. Halushka M.K., Heide R.S. Myocarditis is rare in COVID-19 autopsies: cardiovascular findings across 277 postmortem examinations. Cardiovasc. Pathol, 2021, vol. 50, pp. 107300. doi: 10.1016/j.carpath.2020.107300.
40. Mitrofanova L.B., Makarov I.A., Runov A.L., Vonsky M.S., Danilova I.A., Sidorin V.S., Moiseva O.M., Conradi A.O. Kliniko-morfologicheskoe i molekulyarno-biologi-cheskoe issledovanie miokarda u pacientov s COVID-19 [Clinical, morphological and molecular biological examination of the myocardium in COVID-19 patients]. Russ J Cardiol, 2022, vol. 27(7), pp. 147-157. (in Russian).
41. Brener M.I., Hulke M.L., Fukuma N., et al. Clinico-histopathologic and single-nuclei RNA-sequencing insights into cardiac injury and microthrombi in critical COVID-19. JCI Insight, 2022, vol. 7(2), pp. e154633. doi: 10.1172/jci.insight.154633.
42. Pleshko A.A., Petrova E.B., Gunich S.V., Rakovich S.V., Grigorenko E.A., Mitkovskaya N.P. Koronavirusnaya infekciya (SARS-COV-2): fokus na SOVID-19 associirovannuyu koagulopatiyu [Pathophysiological features of coronavirus infection (SARS-COV-2): focus on COVID-19 associated coagulopathy. Neotlozhnaya Kardiologiya Kardiova-skulyarnye Riski, 2021, vol. 5(1), pp. 1223-1233. (in Russian).
43. Chen W., Pan J.Y. Anatomical and Pathological Observation and Analysis of SARS and COVID-19: Microthrombosis Is the Main Cause of Death. Biol Proced Online, 2021, vol. 23(1), pp. 4. doi: 10.1186/s12575-021-00142-y.
44. ESC Guidance for the Diagnosis and Management of CV Disease during the COVID-19 Pandemic [electronic resource]. Available at: https://www.escardio.org/Education/COVID-19-and-Cardiology/ESC-COVID-19-Guidance, https://www.escardio.org/Education/COVID-19-and-Cardiology/ESC-COVID-19-Guidance. (accessed: 24.03.2023).
45. Castiello T., Georgiopoulos G., Finocchiaro G., Claudia M., Gianatti A., Delialis D., Aimo A., Prasad S. COVID-19 and myocarditis: a systematic review and overview of current challenges. Heart Fail Rev, 2022, vol. 27(1), pp. 251-261. doi: 10.1007/s10741-021-10087-9.
46. Dweck M.R., Bularga A., Hahn R.T., et al. Global evaluation of echocardiography in patients with COVID-19. Eur Heart J Cardiovasc Imaging, 2020, vol. 21(9), pp. 949-958. doi: 10.1093/ehjci/jeaa178.
47. The Right Ventricle in COVID-19 [electronic resource]. Available at: https://www.mdpi.com/2077-0383/10/12/2535. (accessed: 05.06.2023).
48. Ferreira V.M., Schulz-Menger J., Holmvang G., et al. Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation. J Am Coll Cardiol, 2018, vol. 72(24), pp. 3158-3176. doi: 10.1016/j.jacc.2018.09.072.
49. Friedrich M.G., Sechtem U., Schulz-Menger J., et al. Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. J Am Coll Cardiol, 2009, vol. 53(17), pp. 1475-1487. doi: 10.1016/j.jacc.2009.02.007.
50. Ilyina T., Pleshko A., Korotkaya T., Mitkovskaya N. Magnitno-rezonansnaya tomografiya v diagnostike virusnyh miokarditov u pacientov s COVID-19: nereshennye problem [Cardiac magnetic resonance imagining in viral myocarditis in patients with COVID-19: unsolved problems]. Neotlozhnaya Kardiologiya Kardiovaskulyarnye Riski, 2021, vol. 5(2), pp. 1386-1394. (in Russian).
51. Catapano F., Marchitelli L., Cundari G., et al. Role of advanced imaging in COVID-19 cardiovascular complications. Insights Imaging, 2021, vol. 12(1), pp. 28. doi: 10.1186/s13244-021-00973-z.
52. Palmisano A., Gambardella M., D’Angelo T., et al. Advanced cardiac imaging in the spectrum of COVID-19 related cardiovascular involvement. Clin Imaging, 2022, vol. 90, pp. 78-89. doi: 10.1016/j.clinimag.2022.07.009.
Скачать статью
Формат файла: pdf (978.06 Кб)

→ Главная → 2023 том 7, №1