HAS THE FREQUENCY AND MECHANISMS OF CARDIOVASCULAR INVOLVEMENT CHANGED WITH THE EVOLUTION OF COVID-19?
DOI:
https://doi.org/10.11603/1681-2727.2026.1.16165Keywords:
COVID-19, SARS-CoV-2, cardiovascular involvement, myocarditis, hypertension, arrhythmiaAbstract
SUMMARY. COVID-19 is a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since its outbreak in December 2019, it has triggered an unprecedented global pandemic, leading to a worldwide public health crisis. Although SARS-CoV-2 primarily affects the lungs, causing interstitial pneumonia and severe acute respiratory distress syndrome, many patients also develop significant extrapulmonary manifestations, including cardiovascular involvement.
The aim is to analyze the pathogenic mechanisms of cardiovascular injury in patients with COVID-19 and to assess the dynamics of the frequency and mechanisms of cardiovascular system involvement.
The most common cardiovascular manifestations included myocarditis and pericarditis, hypertension, arrhythmia, myocardial injury and heart failure, ischemic heart disease, stress cardiomyopathy, ischemic stroke, coagulation disorders, and dyslipidemia. Two major pathogenic mechanisms of cardiovascular injury may involve direct viral cytotoxicity and indirect hyperimmune responses to SARS-CoV-2 infection.
Conclusions. Cardiovascular involvement in patients with COVID-19 is a frequent occurrence and predicts a worse prognosis. The main pathophysiological mechanisms of cardiovascular injury associated with COVID-19 include both direct SARS-CoV-2-mediated damage to specific morphological structures and indirect hyperimmune reactions. However, a complete understanding of these mechanisms is still pending.
Evidence accumulated during the pandemic and in the post-pandemic period indicates that the incidence of severe acute cardiovascular complications has decreased compared with the early waves of infection (Wuhan/Alpha/Delta), particularly in populations with high vaccination coverage. Nevertheless, the overall risk of incident cardiovascular disease within one year after infection remains higher than in uninfected individuals. According to meta-analyses published in 2023–2024, the risk of cardiovascular events during the first year after COVID-19 remains approximately 1.5–2 times higher than in the general population. Currently, immuno-inflammatory and dysregulatory mechanisms – including cytokine imbalance, endothelial dysfunction, and post-COVID autoimmune reactions – play a predominant role in this pathology.
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