COVID-19: A double threat to takotsubo cardiomyopathy and spontaneous coronary artery dissection?

Shojaei, Fahimehalsadat ¹Habibi, Zahra ²Goudarzi, Sogand ¹Firouzabadi, Fatemeh Dehghani ³Montazerin, Sahar Memar ¹Najafi, Homa ¹Kahe, Farima ¹Momenzadeh, Kaveh ⁴Mir, Mahshid ¹Khan, Faris ⁵Jamil, Umer ⁶Jamil, Adeel ⁶Lee, Jane J. ⁷Chi, Gerald¹

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作者信息

1. Harvard Med Sch, Dept Med, Beth Israel Deaconess Med Ctr, Div Cardiovasc Med, 930 Commonwealth Ave
2. Univ Geneva, Global Studies Inst, Geneva, Switzerland
3. Univ Tehran Med Sci, Vali Asr Hosp, Endocrinol & Metab Res Ctr, Sch Med, Tehran, Iran
4. Harvard Med Sch, Dept Orthoped Surg, Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA
5. Univ Nebraska Med Ctr, Dept Med, Div Cardiol, Omaha, NE USA
6. St Francis Med Ctr, OSF Healthcare, Dept Med, Peoria, IL USA
7. Baim Inst Clin Res, Boston, MA USA
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Abstract

Coronavirus disease 2019 (COVID-19) is an ongoing pandemic that has affected millions of individuals worldwide. Prior studies suggest that COVID-19 may be associated with an increased risk for various cardiovascular disorders, such as myocardial injury, arrhythmia, acute coronary syndrome, and venous thromboembolism. Early reports of non-COVID-19 patients have described the concurrence of takotsubo cardiomyopathy (TTC) and spontaneous coronary artery dissection (SCAD). However, the interplay between COVID-19, TTC and SCAD has not been well established. We herein propose two sets of two-hit hypotheses for the development of SCAD and TTC in the context of COVID-19. The first two-hit hypothesis explains the development of SCAD, in which TTCassociated formation of vulnerable coronary substrate serves as the first hit (predisposing factor), and COVID-19associated inflammation and vascular disruption serves as the second hit (precipitating factor). The second two hit hypothesis is proposed to explain the development of TTC, in which SCAD-associated formation of vulnerable myocardial substrate serves as the first hit, and COVID-19-associated sympathetic overactivity serves as the second hit. Under this conceptual framework, COVID-19 poses a double threat for the development of SCAD (among patients with underlying TTC) as well as TTC (among patients with underlying SCAD), thereby forming a reciprocal causation. This hypothesis provides a rationale for the joint assessment of TTC and SCAD in COVID-19 patients with pertinent cardiovascular manifestations.

Key words

COVID-19/Takotsubo cardiomyopathy/Spontaneous coronary artery dissection/Stress cardiomyopathy/Acute coronary syndrome

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出版年

2021

Medical hypotheses

SCI

ISSN：0306-9877

被引量1

参考文献量33

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