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The heart and vessels express ACE2, which is the target of the SARS-CoV-2 virus in the lungs. In this way, the heart and vessels could also become targets of the virus. At present, the potential involvement of SARS-CoV-2 in the heart is unknown. Myocardial injury, and cardiac troponin elevation, in COVID-19 occurs due to nonischemic processes. These may include hypoxic respiratory infection, sepsis, systemic inflammation, pulmonary thrombosis and embolism, cardiac adrenergic hyperstimulation during cytokine storm syndrome, and myocarditis.
At present, there is limited evidence regarding the direct infection of SARS-CoV-2 of the myocardium. More studies and autopsy findings will help explain the cause of myocarditis in COVID-19 and the direct influence of the virus on the heart and vessels.
This abstract is available on the publisher's site.
The initial mechanism for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is the binding of the virus to the membrane-bound form of ACE2, which is mainly expressed in the lung. Since the heart and the vessels also express ACE2, they both could become targets of the virus. However, at present the extent and importance of this potential involvement are unknown. Cardiac troponin levels are significantly higher in patients with more severe infections, patients admitted to intensive care units or in those who have died. In the setting of COVID-19, myocardial injury, defined by an increased troponin level, occurs especially due to non-ischaemic myocardial processes, including severe respiratory infection with hypoxia, sepsis, systemic inflammation, pulmonary thrombosis and embolism, cardiac adrenergic hyperstimulation during cytokine storm syndrome, and myocarditis. At present, there are limited reports on definite diagnosis of myocarditis caused by SARS-CoV-2 in humans and limited demonstration of the virus in the myocardium. In conclusion, although the heart and the vessels are potential targets in COVID-19, there is currently limited evidence on the direct infection of the myocardium by SARS-CoV-2. Additional pathological studies and autopsy series will be very helpful to clarify the potentiality of COVID-19 to directly infect the myocardium and cause myocarditis.