Although the lungs represent the first target, it has often been suggested that cardiovascular implications are frequent in COVID-19, both in its acute stages as well as during recovery. Another potential pathway is mediated via the macrophages, responsible for the initiation of the hypoxia-inducible factor (HIF-1α). In some individuals, these immune responses can become exaggerated, resulting in an augmented release of cytokines-namely, the “cytokine storm”. Therefore, the virus determines the release of large amounts of proinflammatory cytokines, namely interleukine-6 (IL-6) and interleukine-1β (IL-1β), but also of other acute phase mediators, such as ferritin and C-reactive protein, Figure 1. Ĭurrently, it has been proven that theSARS-CoV-2 virus exerts its actions both directly, by binding on the cell surface receptors, but also through immunological mediated effects, by activating the innate and adaptive immunity. Surprisingly, a worse evolution, with a large spectrum of systemic complications-often requiring admission in intensive care units (ICUs) and resulting in fatal outcome-was observed, not only in elderly and frail patients that had multiple comorbidities, but also in younger, apparently healthy subjects, especially when they had associated metabolic dysfunctions such as visceral obesity, metabolic syndrome (MS), and type 2 diabetes mellitus (T2DM). After 6 months, LVF and RVF appeared to normalize, however, the DD-although somewhat improved-did persist in approximately a quarter of patients with MD, possibly due to chronic myocardial changes.Įver since the beginning of 2020, as the infection with a new variant of the severe acute respiratory syndrome (SARS-CoV-2) virus spread worldwide and progressed rapidly to an alarming pandemic, it was evident that the severity, prognosis, and mortality rates of COVID-19 varied largely among infected populations. (4) Conclusions: in diabetic patients with MS and/or obesity with comorbid post-acute COVID-19 syndrome, a comprehensive TTE delineates various cardiovascular alterations, when compared with controls. Significant predictive values for the initial C-reactive protein and TyG index levels, both for the initial and the 6-month follow-up levels of these TTE abnormalities ( p ˂ 0.001), were highlighted by means of a multivariate regression analysis. Statistically significant associations between TTE parameters and the number of factors defining MS, the triglyceride-glucose (TyG) index, the severity of the SARS-CoV-2 infection, and the number of persisting symptoms ( p ˂ 0.001) were noted. (2) Methods: Our aim was to document, by transthoracic echocardiography (TTE), the presence of cardiac alterations in 112 patients suffering from post-acute COVID-19 syndrome and T2DM, MS, and/or obesity, in comparison to 91 individuals without metabolic dysfunctions (MD) (3) Results: in patients with MD, TTE borderline/abnormal left (LVF) and/or right ventricular function (RVF), alongside diastolic dysfunction (DD), were more frequently evidenced, when compared to controls ( p ˂ 0.001). (1) Background: Throughout the COVID-19 pandemic, it became obvious that individuals suffering with obesity, diabetes mellitus (T2DM), and metabolic syndrome (MS) frequently developed persisting cardiovascular complications, which were partially able to explain the onset of the long-COVID-19 syndrome. Therefore, besides the usual post-COVID-19 assessments, patients with an increased metabolic risk profile should be supplementarily evaluated by a cardiologist, including by a comprehensive echocardiography, both during the acute infection as well as in the recovery period. These cardiac pathologies, such as the altered systolic and diastolic functions and/or the presence of pulmonary hypertension, could explain-at least partially-the development of long COVID-19 syndrome. At the 3- and 6-month follow-up, we observed that the echocardiographic parameters characterizing the left and right ventricular function, as well as the increased pressure in the pulmonary artery, had improved, which was not the case for diastolic dysfunction (mostly of type 3). We demonstrated that during the recovery from COVID-19, the above-mentioned pathologies, associated with an increased inflammatory burden, favor the development of various cardiac alterations-which are diagnosable by transthoracic echocardiography-in previously healthy individuals. In this original article, we aimed to describe the immense influence of an augmented metabolic risk profile, such as the case of type 2 diabetes mellitus, metabolic syndrome, and obesity, on the evolution of a SARS-CoV-2 virus infection, with a focus on the cardiovascular abnormalities encountered in post-acute COVID-19 syndrome.
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