urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/2071-5943-2021-20-5-98-104urmj-855Research ArticleОБЗОРЫ ЛИТЕРАТУРЫLITERATURE REVIEWSОстрое поражение миокарда при новой коронавирусной инфекции (COVID-19)Acute myocardial damage in new coronavirus infection (COVID-19)https://orcid.org/0000-0001-7826-9657ИзможероваН. В.IzmozherovaN. V.

Надежда Владимировна Изможерова — доктор медицинских наук

Екатеринбург

Nadezhda V. Izmozherova — Doctor of Science (Medicine)

Ekaterinburg

nadezhda_izm@mail.ruhttps://orcid.org/0000-0001-6216-2468ПоповА. А.PopovA. A.

Артем Анатольевич Попов — доктор медицинских наук

Екатеринбург

Artem A. Popov — Doctor of Science (Medicine)

Ekaterinburg

art_popov@mail.ruhttps://orcid.org/0000-0002-8751-6872ЦветковA. И.TsvetkovA. I.

Андрей Игоревич Цветков — кандидат медицинских наук, доцент

Екатеринбург

Andrej I. Tsvetkov — MD, Associate Professor 

Ekaterinburg

cp-gendir@mail.ruhttps://orcid.org/0000-0001-7312-415XШамбатовМ. А.ShambatovM. A.

Мураз Акбар оглы Шамбатов — аспирант

Екатеринбург

Muraz A. Shambatov — Postgraduate student

Ekaterinburg

shambatovma@gmail.comhttps://orcid.org/0000-0002-9957-2505АнтроповаИ. П.AntropovaI. P.

Ирина Петровна Антропова — доктор биологических наук

Екатеринбург

Irina P. Antropova — Doctor of Science (Biology)

Ekaterinburg

ip.hemolab@mail.ruhttps://orcid.org/0000-0002-2623-2657КадниковЛ. И.KadnikovL. I.

Леонид Игоревич Кадников — аспирант

Екатеринбург

Leonid I. Kadnikov — Postgraduate student

Ekaterinburg

kadn-leonid@mail.ruИспавскийВ. Е.IspavskyV. E.

Владислав Евгеньевич Испавский — аспирант

Екатеринбург

 

Vladislav E. Ispavsky — Postgraduate student

Ekaterinburg

ispavsky@yandex.ruФГБОУ ВО «Уральский Государственный Медицинский Университет» Минздрава РоссииРоссияUral State Medical UniversityRussian FederationФГБОУ ВО «Уральский Государственный Медицинский Университет» Минздрава России; ФГБУН Институт высокотемпературной электрохимии УрО РАНРоссияUral State Medical University; The Institute of High Temperature ElectrochemistryRussian Federation20210512202120598104Copyright © Изможерова Н.В., Попов А.А., Цветков A.И., Шамбатов М.А., Антропова И.П., Кадников Л.И., Испавский В.Е., 20212021Изможерова Н.В., Попов А.А., Цветков A.И., Шамбатов М.А., Антропова И.П., Кадников Л.И., Испавский В.Е.Izmozherova N.V., Popov A.A., Tsvetkov A.I., Shambatov M.A., Antropova I.P., Kadnikov L.I., Ispavsky V.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/855Введение

Введение. Острый респираторный дистресс-синдром и сердечно-сосудистые осложнения, наиболее частым из которых является острое повреждение миокарда (ОПМ), занимают ключевое место в структуре причин смерти больных с новой коронавирусной инфекцией. Отсутствие единого мнения о механизмах развития острого поражения миокарда, обоснованной тактики ведения пациентов с ОПМ, применении антикоагулянтной терапии у лиц с идентифицированным SARS-CoV-2 или подозрением на COVID-19 отражают необходимость поиска, анализа и обобщения имеющихся литературных данных по данной проблеме.

Материалы и методы

Материалы и методы. Поиск и отбор научных публикаций проводился в поисковых системах PubMed, Google Scholar за период с декабря 2019 по сентябрь 2021 гг.

Результаты и обсуждения

Результаты и обсуждения. Повышение кардиоспецифичного тропонина I выявляется по меньшей мере у каждого десятого пациента с идентифицированным SARS-CoV-2, частота выявления повышенного уровня тропонина возрастает среди лиц со среднетяжелыми и тяжелыми формами инфекции. Механизм острого поражения миокарда у пациентов с COVID-19 малоизучен, на сегодня имеется несколько теорий патогенеза: высокая частота развития вирусного миокардита обусловливает прямое повреждение кардиомиоцитов вследствие высокой аффинности SARS-CoV-2 к ангиотензинпревращающему ферменту 2, экспрессируемому в миокарде; повреждение миокарда в рамках полиорганной недостаточности вследствие цитокинового шторма; повреждение микроциркуляторного русла при развитии коагулопатии. До трети летальных случаев у лиц, инфицированных 2019-nCoV, ассоциировано с развитием острого повреждения миокарда. При этом ввиду высокой частоты развития острого поражения миокарда достаточно сложно оценить истинную частоту развития острого инфаркта миокарда у больных COVID-19. В условиях пандемии возрастает время ожидания медицинской помощи, население, пытаясь сократить социальные контакты, реже обращается за медицинской помощью. В связи с этим для оказания эффективной медицинской помощи больным с ОИМ необходимо выработать алгоритмы оказания помощи, адаптированные к текущей эпидемиологической ситуации.

Заключение

Заключение. Лечение пациентов с вероятным развитием острого повреждения миокарда на фоне новой коронавирусной инфекции должно проводиться в соответствии с текущими клиническими рекомендациями. Назначение антикоагулянтной терапии необходимо осуществлять в профилактической дозе под контролем показателей гемостаза и широкого спектра биохимических показателей.

Introduction

Introduction. Acute respiratory distress syndrome (ARDS) and cardiovascular events, acute myocardial injury being the most frequent of the latter, are among the leading causes of death in COVID-19 patients. The lack of consensus on acute myocardial injury pathogenesis mechanisms, the patients management, treatment an rehabilitation logistics, the anticoagulant treatment in identified SARS-CoV-2 or suspected COVID-19 patients setting indicates the need to assess, analyze and summarize the available data on the issue.

Materials and methods

Materials and methods. Scientific publications search was carried out in PubMed, Google Scholar databases for the period from December 2019 to September 2021.

Results and Discussion

Results and Discussion. Cardiospecific troponin I increase beyond reference limits is reported to occur in at least every tenth patient with identified SARS-CoV-2, the elevated troponin detection rate increasing among persons with moderate to severe course of the infection. The mechanisms of acute myocardial injury in patients with COVID-19 are poorly understood. By September 2021, there are several pathogenesis theories. A high frequency viral myocarditis direct cardiomyocytes damage is explained by the high SARS-CoV-2 affinity to ACE2 expressed in the myocardium. The cytokine storm related myocardial damage is reported a multiple organ failure consequence. Coagulopathy may also trigger myocardial microvessels damage. Up to every third death of SARS-CoV-2 infected persons is related to the acute myocardial injury. At the same time, due to the high incidence of the acute myocardial injury, it is rather difficult to assess the true incidence of acute myocardial infarction in patients with COVID-19. In the pandemic setting, the waiting time for medical care increases, the population, trying to reduce social contacts, is less likely to seek medical help. In this regard, in order to provide effective medical care to patients with acute myocardial infarction, it is necessary to develop algorithms for providing care adapted to the current epidemiological situation.

Conclusion

Conclusion. The treatment of patients with probable development of acute myocardial damage against the background of new coronavirus infection should be performed in accordance with the current clinical guidelines. Anticoagulant therapy should be administered in a prophylactic dose under control of hemostasis parameters and a wide range of biochemical parameters.

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The authors declare that there are no conflicts of interest present.