Review
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 21, 2022; 10(3): 762-776
Published online Jan 21, 2022. doi: 10.12998/wjcc.v10.i3.762
Acute myocardial injury in patients with COVID-19: Possible mechanisms and clinical implications
Iulia Rusu, Malina Turlacu, Miruna Mihaela Micheu
Iulia Rusu, Malina Turlacu, Miruna Mihaela Micheu, Department of Cardiology, Clinical Emergency Hospital of Bucharest, Bucharest 014461, Romania
Author contributions: Rusu I and Turlacu M contributed to this paper with literature review, analysis and drafting the paper; Micheu MM contributed to conception and design of the study, literature analysis, critical revision, and editing; all authors approved the manuscript final version.
Conflict-of-interest statement: All authors declare there are no potential conflicts of interests, as there was no financial support for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Miruna Mihaela Micheu, MD, PhD, Department of Cardiology, Clinical Emergency Hospital of Bucharest, Floreasca Street 8, Bucharest 014461, Romania. mirunamicheu@yahoo.com
Received: April 27, 2021
Peer-review started: April 27, 2021
First decision: June 15, 2021
Revised: June 15, 2021
Accepted: December 21, 2021
Article in press: December 21, 2021
Published online: January 21, 2022
Abstract

Severe acute respiratory syndrome coronavirus 2 infection affects not only the lungs, but also the cardiovascular system, having a major impact on patients’ outcomes. Myocardial injury (MI) occurs in the context of coronavirus infectious disease 2019 (COVID-19) and is associated with a higher risk of severe clinical outcome and mortality. COVID-19-related MI can have various clinical manifestations, of which the main ones are myocarditis, stress cardiomyopathy, acute coronary syndrome, and pulmonary embolism. The exact mechanisms of how MI occurs in these patients are not yet fully known. Direct injury, through direct viral myocardial invasion, and indirect injury, through interaction with angiotensin I converting enzyme 2, increased inflammation, and thrombocyte and endothelial dysfunction, could be involved in acute MI in patients with COVID-19. A better understanding of these multiple potential mechanisms may help to develop new targeted therapeutic strategies. The purpose of this review is to provide the current understanding of the potential mechanisms involved in MI induced by COVID-19 and to discuss the current progress in the therapeutic strategies.

Keywords: Myocardial injury, Myocarditis, Stress cardiomyopathy, Acute coronary syndrome, Pulmonary embolism, Coronavirus infectious disease, SARS-CoV-2

Core Tip: Myocardial injury (MI) has been described in coronavirus infectious disease 2019 patients and is associated with a higher risk of severe clinical outcome and mortality, but the exact mechanisms involved are not completely elucidated. Multiple potential mechanisms have been proposed, such as direct viral infection and indirect injury through inflammation, angiotensin I converting enzyme 2 interaction and hemostatic anomalies. Understanding the mechanisms underlying MI is needed to guide effective therapeutic strategies in these patients.