The new koronavirusny infection (COVID-19) caused by a coronavirus of a heavy acute respiratory syndrome 2 types (SARS-CoV-2) keeps the nature of a pandemic and is characterized by high incidence and mortality. As well as at SARS infection in 2003, development of a new koronovirusny infection, as a rule, is followed by the acute respiratory distress syndrome (ARDS) representing the acute process in lungs leading to high mortality at patients with COVID-19. However appears more and more data indicating such complication as the injury of a myocardium connected with COVID-19 infection with a frequency from 7.2% to 12%.
The heavy respiratory distress syndrome usually is considered as the leading cause of death, the caused koronavirusny infection. In a recent research on the greatest clinical selection in China heavy pneumonia was independently connected with receipt in ORIT, artificial ventilation of the lungs and death. Other complications were also connected with higher risk of intrahospital lethality. Also report that at the hospitalized patients the renal failure was connected with COVID-19 with higher risk of death in 3.2%.
Despite limited information on cardiological complications at patients with COVID-19, it was shown that dysfunction of heart is a direct or background cause of death in 27% of cases of death of pneumonia. Even after the amendment on initial risk, cardiological complications were connected with increase in lethality in the short-term period at patients with pneumonia for 60%.
Nevertheless, now there are not enough data to assume higher probability of development of an infection of COVID-19 in patients with cardiovascular diseases. Besides, broader and representative selection is necessary for definition of an exact indicator of lethality from COVID-19 as lethality differs in different regions and in different timepoints. In one research patients with a heavy current of COVID-19 which died in hospital, as a rule, had accessory factors of risk, such as more advanced age, bigger quantity of associated diseases and a deviation of laboratory indicators, they to a thicket needed carrying out noninvasive or invasive ventilation of the lungs. Analyzing potential risk factors of a lethal outcome, it was revealed that set of such factors as more advanced age, the frequency of chronic heart diseases, the raised inflammatory answer and injury of a myocardium, affected risk of death. Other authors reported that more advanced age was connected with development and progressing of ORDS up to death at patients with the pneumonia caused by COVID-19.12 in general advanced age has significant effect on complications and lethality at patients with COVID-19.
Increase in level of a troponin and KFK-MV can increase risk of the predicted death. It is remarkable that despite it, there can be a quantity of patients with the normal level of markers of injury of a myocardium at receipt in a hospital. To speak still prematurely whether the failure at these patients as according to researches only about 30% of such patients died from injury of a myocardium is predetermined, however levels of these markers play an important role as an early predictor of a possible lethal outcome at the patient with COVID-19.
To injury of a myocardium at COVID-19 the inflammation mediators (cytokines and/or endotoxins) circulating in blood or a direct virus invasion can bring into cardiomyocytes, or both mechanisms. Recently there was information that the new coronavirus uses an angiotensin-converting enzyme of the II type (APF2) as a receptor for an entrance to a cell, and SARS-CoV was found in heart in 35% of patients that demonstrates that SARS-CoV is capable to infect a myocardium through APF2 receptors. It is possible to claim that the direct invasion of SARS-CoV-2 in cardiomyocytes is the cornerstone of dysfunction of heart, however in recently conducted histopathological research at the patient with COVID-19 rare intersticial mononuclear inflammatory infiltrates in heart fabric without significant injury of a myocardium are registered. Considering poor data, still it is necessary to establish whether can lead SARS-CoV-2 to direct injury of heart.
Thus, the risk of an intrahospital lethal outcome at patients with a heavy infection of COVID-19 to some extent can be predicted by means of markers of injury of a myocardium, and it is substantially connected with advanced age, the inflammatory answer and the accompanying cardiovascular diseases.