The role of cardiovascular system in the SARS-CoV-2 infection and aggravation in human

Abstract

The coronavirus disease (COVID-19) has several clinical manifestations, highlighting a large number of cases and deaths in patients with specific comorbidities, such as cardiovascular diseases. For this reason, the objective was to analyze the role of the cardiovascular system in SARS-CoV-2 infection and complications in patients with pre-existing cardiovascular alterations. For this, a systematic search was carried out following the PRISMA guidelines in the Latin American and Caribbean Health Sciences Literature databases (Lilacs) and PubMed/Medline, using the association of descriptors: (“Cardiovascular System” OR Cardiovascular Diseases OR “Heart Failure” OR “Hypertension” OR “Cardiac Insufficieny”) AND (“COVID 19”). Original studies published from 2020 onwards were included. Results: About 16/18 studies dealt with complications and 2 with a higher rate of infection in patients with preexisting CVD. The cardiovascular comorbidity most associated with the severity of COVID-19 was systemic arterial hypertension. And through a meta-analysis of the included studies, it was concluded that previously hypertensive patients may be up to 2.49 times more likely to have a worse prognosis. Related to a higher infection rate, both studies showed that patients with SAH have a greater amount of angiotensin-converting enzyme 2 (ACE 2), which functions as a receptor for the binding of SAR-CoV-2, presenting a potentially greater risk of infection. The 16 studies on complications associated the manifestations of venous, arterial and microvascular thrombosis with increased prothrombotic signaling and increased release of von Willebrand factor and platelet activation/aggregation, in addition to increased anti-fibrinolytic and immunoactivating activity specific to cardiac fibroblasts in the hearts of patients with COVID-19. Severe cases were associated with systemic microcirculatory changes with endothelial dysfunction, higher troponin levels, higher values of inflammatory markers, with pro-inflammatory and procoagulant status, atrial fibrillation, and high rates of septic shock. Conclusion: It is inferred that COVID-19 in patients with previous CVD, mainly SAH, have a greater chance of infection due to increased expression of ACE 2 and to present manifestations of thrombosis associated with a pro-coagulant state and inflammatory manifestations associated with a pro-state. -inflammatory triggering a higher rate of hospitalization, resulting in serious complications, requiring intensive treatment, and in some cases death.