Cardiac magnetic resonance imaging shows inflammation after the recovery of Covid-19

Renting any presumption of inevitable heart failure on a non-randomized CMR study with 100 non-selected participants is premature and potentially scary.

Almost immediately after the publication, the professors Darrel Francis and Graham Cole from the United Kingdom found in a Twitter feed that the data points and results in Table 1 of the paper were mathematically impossible. Analyzed again, added a lack of data and wrote an answer, 4 and Jama cardiology corrected the original online version (errors in statistical numbers and data). In the renewed analysis, the mass of the left ventricle in the recovered group was not higher, but all other measurements retained their statistical significance.

Since Covid-19 was reported for the first time less than a year ago, a lot has been found about his relationship with heart disease. The presence of a pre-existing cardiovascular disease and its risk factors high blood pressure, diabetes, smoking and obesity are associated with a higher rate of hospital stays and deaths in connection with Covid-19. Cardiovascular disease. 6 A myocardial damage, measured by troponin, is common in patients who were hospitalized with Covid-19. In a series of 3,000 patients who were hospitalized in the Mount Sinai Medical Center in New York City, 36 % signs of a myocardial injury. ^{7 This was associated with a higher death rate. In the series of 39 successive autopsies of patients who died of COVID-19-related causes, 61 % showed references to viruses in heart cells. 2 In an 11-year-old girl who died of a multi-system syndrome in connection with COVID-19, the virus in cardiomyocytes, endo cells, endow cells, Menchym cells and inflammatory cells observed. 8 The authors placed the hypothesis that the virus caused myocarditis directly in this child.}

These studies raise the following questions:

• Covid-19 attacks the heart directly and damages it permanently?
• How long does heart inflammation according to Covid-19?
take
• should inflammation markers be used as screening instruments for people with a history of Covid-19?
• will cardiomyopathy and heart failure develop from a covid 19-related heart inflammation?
• Although CMR enables the visualization of heart infections, how should doctors use them in clinical practice?

Runing any presumption of inevitable heart failure on a non-randomized CMR study with 100 non-selected participants is premature and potentially scary. Additional research with long-term follow-up in selected populations is required. Studies on Covid-19 survivors are in progress to help answer these questions and to conclude the cardiac aftercare of a Covid 19 pneumonia (clinicaltrials.gov nct04501822), participants with cardiomyopathy (clinicaltrials.gov nct04468256) and survivors with acute Coronary syndrome (clinicalaltrials.gov NCT0433407).

What do we know and what can now be done for the care of our patients? There are currently no proven treatments with herbs or nutritional supplements for Covid-19, but measures that are known to reduce heart infections and hide little or no risk can be indicated.

correlation studies suggest the consideration of vitamin D, omega-3 fatty acids and melatonin. In a retrospective study with 489 patients, in whom a vitamin D level was measured within one year before the Covid-19 test, 71 were positively tested for Covid-19. ⁹ The authors came to the conclusion that a vitamin D deficiency (25-hydroxycholecalcalciferol was less than 20 n 1,25-dihydroxycholecalciferol less than 18 pg/ml) was associated with an absolute risk of 21.6 % for COVID-19, in contrast to a risk of 12.2 % in vitamin D.

The anti-inflammatory omega-3 fatty acids Eicosapentaenic acid (EPA) and Docosahexaenic acid (DHA) have used a proven cardiovascular use. EPA and DHA supplementation The O2 saturation, reduced the duration of the hospital stay and reduced mortality after 28 days. ¹²

melatonin is another candidate in the fight against Covid-19. Melatonin is a well-known antioxidant and anti-inflammatory agent with a good safety profile that is examined in a double-blind, randomized, placebo-controlled study of outpatient patients who are infected with COVID-19 (Clinicals.Gov NCT04474483).

Finally, there are 2 medication classes to mention: statins and ACE inhibitors. In a meta-analysis that included 8,990 Covid 19 patients, the use of statins correlated with an incidence of about 30 %. In the first few months of pandemic, the fear was that angiotensin concerting enzyme (ACE) inhibitors could increase the infection because they lead to a high regulation of ACE 2 receptors, the docking division of SARS-COV-2. Current ratings 14 and a randomized study Fifteen point out that these medication can be continued in patients with covid-19.

Both the medications mentioned and the dietary supplements have immunomodulatory effects that reduce several ways that are involved in the heart inflammation. There is no data to initiate statins and ACE inhibitors during a covid-19 diagnosis, but the evidence indicates that these medication should not be stopped during the disease. Vitamin D, omega-3 fatty acids and melatonin are generally well tolerated and have a good security profile. Your introduction and sequel during Covid-19 is probably safe and possibly advantageous.

The strongest anti-inflammatory inhibitor is in my opinion the avoidance of the inflammatory stimulus, in this case Sars-Cov-2. Prevention by masking, physical distancing and a healthy lifestyle are the most reliable means of avoiding the possible cardiac consequences of an infection.