COVID - 19 and Cardiovascular System

.: PREFACE
ÖN SÖZ
PREFACE
Prof. Dr. Dursun DUMAN
İstanbul Medipol Üniversitesi Tıp Fakültesi, Kardiyoloji ABD, İstanbul, Türkiye
Article Language: TR
31 aralık 2019 tarihinde Çin'in Wuhan şehri Belediye Sağlık Komisyonu (Hubei Eyaleti, Çin), ilk nedeni bilinmeyen bir dizi pnömoni vakası rapor etti.1 Çinli yetkilliler 7 ocak 2020 tarihinde yeni bir koronavirüs tipini izole ettiklerini bildirdi. Bu virüs Dünya Sağlık Örgütü (WHO) tarafından COVID-19 olarak adlandırıldı. Solunum yolları ve kardiyovasküler komplikasyonları çok ağır ve yıkıcı seyreden bu hastalık, kısa süre içinde tüm dünyaya yayıldı. WHO, COVID-19'u halk sağlığı açısından 30 ocak 2020 tarihinde acil durum, 11 mart 2020 tarihinde de ise pandemi olarak ilan etti.2

Pandeminin ilk yılında virüsün akciğer hasarına neden olarak riski artırdığı rapor edildi. Ancak COVID-19 pandemisinin ikinci yılından itibaren, hastalığın akciğer tutulumu dışında, miyokardit, perikardit, akut koroner sendrom, derin ven trombozu, kardiyak aritmi, pulmoner ve serebral emboliye neden olduğu yönünde çok sayıda yayın yapıldı. Ayrıca, COVID-19'un daha önce kardiyovasküler hastalık tanısı almış ya da hipertansiyon, diyabet, sigara ya da obezite gibi risk faktörleri taşıyan hastalarda çok daha ağır seyrettiği gösterildi. Yine bu dönemde hipertansiyon tanısı almış hastalarda anjiotensin konverting enzim (ACE) inhibitörü ve anjiotensin reseptör blokeri (ARB) kullanımının COVID-19 enfeksiyonunda riski artırabileceği yönünde yayınlar tartışmaya neden oldu. Ancak daha sonra yapılan meta-analizlerde COVID-19 enfeksiyonu sırasında bu ilaçların kullanılmasının riski artırmadığı sonucuna varıldı. 3-8

COVID-19 pandemisi başladığı 2020 yılı başından itibaren tüm dünyada, sosyo-ekonomik, siyasal ve eğitim alanında köklü değişikliklere ve kötüleşmeye neden oldu. Sağlık örgütleri tarafından küresel anlamda halk sağlığını tehdit eden acil durum olarak kabul edilen bu hastalık, tüm dünya genelinde halka açık toplantıların kısıtlanması, evde kalma emirleri, yüz yüze eğitimin aksaması gibi, dünya tarihinde ender görülen kararların uygulanmasına neden oldu. 16 Ekim 2021 tarihi itibariyle COVID-19 ile enfekte kişi sayısı 241.562.000 ve rapor edilen toplam ölü sayısı 4.915.000'tir. Son iki yılda virüsün sürekli mutasyona uğrayıp özellikle sonbahar ve kış aylarında pik yaptığı ikinci dalganın yaşandığı bu dönemde, toplam 15 aşı için acil kullanım onayı verildi. 16 Ekim 20121 tarihi itibariyle, dünya genelinde toplam 6.67 milyar doz COVID-19 aşısı yapılmış, tüm dünya genelinde ise en az 1 doz aşı yapılma oranı %47.6'ya ulaşmıştır.9 Bu yüksek aşılama oranına rağmen tüm dünyada günlük vaka sayısı 16 Ekim2021 tarihi itibariyle 46.865 ve virüse bağlı günlük ölü sayısı ise 5.400 olarak bildirilmiştir. Toplum bağışıklığın oluşması için gerekli en düşük oran olan %80 aşılama oranına ulaşılamaması, yoksul ve az gelişmiş ülkelerin aşıya ulaşamaması ve bu ülkelerde oldukça düşük aşılama oranları, virüsün sürekli mutasyon geçirip, aşıya dirençli yeni suşların ortaya çıkması gibi birçok nedene bağlı olarak hastalıkla mücadelede yeterli başarı sağlanamamıştır. COVID-19 pandemisinin önümüzdeki bir yıl içinde tam olarak kontrol altına alınması mümkün görünmemektedir. Şu ana kadar yapılan 2. ve hatta 3. doz COVID-19 aşılarının hastalığı kontrol etmede yeterli olmadığı daha fazla aşılamaya gereksinim duyulacağı öngörülmektedir. Ancak daha çok 30 yaş altı bireylerde 2. doz mRNA aşısı sonrası miyokardit ve perikardit, replike olmayan adenovirüs vektör bazlı aşılar [AstraZeneca COVID-19 ChAdOx-1 aşısı Johnson & Johnson (J&J) Janssen COVID-19 Ad26.COV2-S aşısı] sonrası tromboz, emboli ve trombositopeni sendromu gibi aşı sonrası seyrek olarak gelişen komplikasyonlar yakından takip edilmekte ve endişe yaratmaktadır.10 Önümüzdeki yıllarda üçüncü, dördüncü ya da daha fazla doz COVID-19 aşısı yapılması durumunda uzun dönemde hangi komplikasyonların gelişebileceği konusunda soru işaretleri devam etmektedir.

Bu bilgiler ışığında COVID-19 ve kardiyovasküler hastalık ilişkisi ile ilgili literatürde yer alan araştırma sonuçlarının bir araya getirilmesi, bu hastalıkla özverili şekilde mücadele eden sağlık çalışanları ve akademisyenler için oldukça önem arz etmektedir. Bu kitap; COVID-19'da kardiyovasküler sistem tutulumu, bu tutulumun klinik tanısı, altta yatan mekanizmaları ve tedavisi konusunda güncel bilgileri bir araya getirmeyi ve geleceğe ışık tutmayı hedeflemektedir.

Prof. Dr. Dursun DUMAN
Editör

KAYNAKLAR

1. Wu JT, Leung K, Bushman M, Kishore N, Niehus R, de Salazar PM, et al. Estimating clinical severity of COVID-19 from the transmission dynamics in Wuhan, China. Nat Med. 2020;26(4):506-10. Erratum in: Nat Med. 2020;26(7):1149-50.
2. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200121-sitrep-1-2019-ncov.pdf (Erişim tarihi: 20.10.2021)
3. Sandoval Y, Januzzi JL Jr, Jaffe AS. Cardiac troponin for assessment of myocardial injury in COVID-19: JACC review topic of the week. J Am Coll Cardiol. 2020;76(10):1244-58.
4. Giustino G, Croft LB, Stefanini GG, Bragato R, Silbiger JJ, Vicenzi M, et al. Characterization of myocardial injury in patients with COVID-19. J Am Coll Cardiol. 2020;76(18):2043-55.
5. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7):811-8. Erratum in: JAMA Cardiol. 2020;5(7):848.
6. Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5(7):802-10.
7. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. Erratum in: Lancet. 2020;395(10229):1038. Erratum in: Lancet. 2020;395(10229):1038.
8. Hippisley-Cox J, Young D, Coupland C, Channon KM, Tan PS, Harrison DA, et al. Risk of severe COVID-19 disease with ACE inhibitors and angiotensin receptor blockers: cohort study including 8.3 million people. Heart. 2020;106(19):1503-11.
9. World Health Organization [İnternet]. © 2021 WHO [Erişim tarihi: 11 Mayıs 2021]. COVID-19 vaccine tracker and landscape. Erişim linki: https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines
10. World Health Organization. Guidance for clinical case management of thrombosis with thrombocytopenia syndrome (TTS) following vaccination to prevent coronavirus disease (COVID-19). Interim guidance 19 July 2021. WHO reference number: WHO/2019-nCoV/TTS/2021.1. Erişim linki: https://apps.who.int/iris/bitstream/handle/10665/342999/WHO2019-nCoV-TTS-2021.1-eng.pdf (Erişim tarihi: 20.10.2021)
Wuhan Municipal Health Commission, China, reported a cluster of cases of pneumonia unknown etiology in Wuhan, Hubei Province. The Chinese authorities identified a new type of coronavirus, which was isolated on 7 January 2020.1 World Health Organization (WHO) described this new type coronavirus as COVID-19. This virus, with severe and devastating respiratory and cardiovascular complications, spread all over the world in a short time.WHO announced the outbreak a Public Health Emergency of International Concern on 30 January 2020, and a pandemic on 11 March 2020.2

In the first year of pandemic, it was mainly reported that virus increases the mortality and morbidity because of the respiratory system involvement. However, since the second year of the COVID-19 pandemic, many publications have been made that the disease causes myocarditis, pericarditis, acute coronary syndrome, deep vein thrombosis, cardiac arrhythmia, pulmonary and cerebral embolism, apart from lung involvement.In addition, it has been shown that COVID-19 is much more severe in patients who have previously been diagnosed with cardiovascular disease or who have risk factors such as hypertension, diabetes, smoking or obesity.3-8 Again in this period, publications suggesting that the use of angiotensin converting enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB) in patients diagnosed with hypertension may increase the risk in COVID-19 infection has caused controversy. However, later meta-analyses concluded that the use of these drugs during COVID-19 infection did not increase the risk.

The COVID-19 pandemic has caused radical changes and worsening in the socio-economic, political and educational fields all over the world since the beginning of 2020. This disease, which is recognized as a global public health emergency by health organizations, has led to the implementation of rare decisions in world history, such as the restriction of public gatherings, stay-at-home orders, and disruption of face-to-face education.

As of 16 November 2021, the number of people infected with COVID-19 is 241,562,000 and the total reported death toll is 4,915,000. In the last two years, during the second wave, when the virus mutates constantly and peaks especially in autumn and winter, a total of 15 vaccines were approved for emergency use. As of November 16, 20121, a total of 6.67 billion doses of COVID-19 vaccine have been administered worldwide, and the rate of at least 1 dose of vaccine worldwide has reached 47.6%.9 Despite this high vaccination rate, the number of daily cases worldwide was 46,865 and the daily death toll due to the virus was 5400 as of November 16, 2021. The reasons for not being successful in the fight against the disease can be summarized as the failure to reach the 80% vaccination rate, which is the lowest rate required for the formation of community immunity, the inability to reach the vaccine in poor and underdeveloped countries, and the very low vaccination rates in these countries, the continuous mutation of the virus and the emergence of new vaccine-resistant strains. It does not seem possible to take the COVID-19 pandemic under full control within the next year. It is predicted that the 2nd and even 3rd dose COVID-19 vaccines made so far are not sufficient to control the disease and more vaccination will be needed.

However, myocarditis and pericarditis after the second dose of mRNA vaccine, mostly in individuals under 30 years of age, thrombosis, embolism and thrombocytopenia syndrome after non-replicating adenovirus vector-based vaccines [AstraZeneca COVID-19 ChAdOx-1 vaccine Johnson & Johnson (J&J) Janssen COVID-19 Ad26.COV2-S vaccine] that develop rarely after , are followed closely and cause concern.10 Questions remain about what complications may develop in the long term if a third, fourth or more dose of COVID-19 vaccine is administered in the coming years.

In the light of this information, bringing together the results of studies and research in the literature on the relationship between COVID-19 and cardiovascular disease is of great importance for healthcare professionals and academics who are selflessly struggling with this disease. This book aims to bring together up-to-date information on cardiovascular system involvement, clinical diagnosis, underlying mechanisms and treatment of this involvement in COVID-19, and to shed light on the future.

Prof. Dr. Dursun DUMAN
Editor

REFERENCES

1. Wu JT, Leung K, Bushman M, Kishore N, Niehus R, de Salazar PM, et al. Estimating clinical severity of COVID-19 from the transmission dynamics in Wuhan, China. Nat Med. 2020;26(4):506-10. Erratum in: Nat Med. 2020;26(7):1149-50.
2. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200121-sitrep-1-2019-ncov.pdf (Erişim tarihi: 20.10.2021)
3. Sandoval Y, Januzzi JL Jr, Jaffe AS. Cardiac troponin for assessment of myocardial injury in COVID-19: JACC review topic of the week. J Am Coll Cardiol. 2020;76(10):1244-58.
4. Giustino G, Croft LB, Stefanini GG, Bragato R, Silbiger JJ, Vicenzi M, et al. Characterization of myocardial injury in patients with COVID-19. J Am Coll Cardiol. 2020;76(18):2043-55.
5. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7):811-8. Erratum in: JAMA Cardiol. 2020;5(7):848.
6. Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5(7):802-10.
7. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. Erratum in: Lancet. 2020;395(10229):1038. Erratum in: Lancet. 2020;395(10229):1038.
8. Hippisley-Cox J, Young D, Coupland C, Channon KM, Tan PS, Harrison DA, et al. Risk of severe COVID-19 disease with ACE inhibitors and angiotensin receptor blockers: cohort study including 8.3 million people. Heart. 2020;106(19):1503-11.
9. World Health Organization [Internet]. © 2021 WHO [Cited: 11 May 2021]. COVID-19 vaccine tracker and landscape. Available from: https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines
10. World Health Organization. Guidance for clinical case management of thrombosis with thrombocytopenia syndrome (TTS) following vaccination to prevent coronavirus disease (COVID-19). Interim guidance 19 July 2021. WHO reference number: WHO/2019-nCoV/TTS/2021.1. Available from: https://apps.who.int/iris/bitstream/handle/10665/342999/WHO2019-nCoV-TTS-2021.1-eng.pdf (Erişim tarihi: 20.10.2021)

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