Abstract

Context: Coronavirus disease 2019 (COVID-19) is a viral infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV 2) that spread around the world rapidly and has become a pandemic and a major global concern. SARS CoV 2 is an enveloped virus with a positive-strand RNA genome that encodes structural and nonstructural viral proteins. Among the structural proteins, spike surface glycoprotein or S protein is necessary for the infection of host cells. Mutations in the S protein can cause dangerous variants of coronaviruses with higher transmission rates that are not easily detectable by routine diagnostic tests and are treatment resistant, leading to a more severe illness and a higher mortality rate. This review aimed to present a comprehensive evaluation of the latest studies on S protein mutations, coronavirus variants, and their relationship with the type, rate, and severity of the cardiovascular disease. Evidence Acquisition: Researchers search GISAID, PubMed/Medline, Google Scholar, Web of Science, Wiley Online Library, and Research Gate for the internationally valid investigation that includes original, reviews, letters or commentaries, or any other published data. Results: Since the outbreak of the COVID-19 pandemic disease, more than 30 mutations in the S protein. The mutations in the S protein increase the affinity and strength of its binding to the host cell receptor. Although the main host of the virus is the respiratory system, Cardiovascular damage, especially myocardial injury, has a significant share in patients with covid-19, which is of great importance due to the increase in the mortality rate. Conclusion: The mutations in the S protein increase the affinity and strength of its binding to the ACE2 receptor. Therefore, the signaling pathways associated with cardiovascular damage and inflammation are activated quickly, causing cardiovascular manifestation, severe forms of the disease, and death as a result of infection with concerning variants of SARS CoV 2.

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