COVID Thiab Kab Mob Ntshav Qab Zib: Peb Paub Li Cas Xyoo 2022

Tus sau:Michael Chilazi1 & Eamon Y. Duffy1 & Aarti Thakkar1 & Erin D. Michol

Abstract

Lub hom phiaj ntawm Kev Tshawb Fawb

Kab mob Coronavirus 2019 (COVID-19) tau ua rau muaj kev mob hnyav thoob ntiaj teb thiab kev tuag.Ntawm no, peb tshuaj xyuas cov ntaub ntawv mus rau hnub tim ntawm qhov tshwm sim luv luv thiab mus sij hawm ntev ntawm qhov mob hnyav ua pa nyuaj.Coronavirus-2 (SARS-CoV-2) virus on the heart.

Cov kev tshawb pom tsis ntev los noCov ntaub ntawv tshaj tawm thaum ntxov tau piav qhia txog cov kab mob plawv ntawm cov hlab plawv ntawm COVID-19, suav nrog myocarditis,kev nyuaj siab cardiomyopathy, myocardial infarction, thiab arrhythmia. Txawm li cas los xij, feem ntau, kev raug mob myocardial hauv COVID-19 tshwmkom tau txais kev kho kom haum xeeb los ntawm qhov mob hnyav ntawm kev mob hnyav dua li kev raug mob ncaj qha rau myocardium los ntawm cov kab mob kis. Thaumcardiac magnetic resonance imaging tseem yog ib qho cuab yeej muaj zog rau kev kuaj mob myocarditis, nws yuav tsum tau siv judiciously hauvLub teeb ntawm qhov qis qis hauv paus ntawm myocarditis. Qhia tus neeg mob kis las los ntawm kev rov qab mus ua si (RTP) tom qab COVID-19kev kis kab mob yog ib txoj kev nyuaj. Cov ntaub ntawv tsis ntev los no qhia tau tias RTP tau ua haujlwm nyab xeeb siv cov txheej txheem tshuaj ntsuam."NtevCOVID" lossis post-acute sequelae of SARS-CoV-2 kab mob kuj tau piav qhia. Cov tsos mob qhia tau nthuav dav davntawm cardiopulmonary thiab neurologic tsis txaus siab nrog rau qaug zog, palpitations, mob hauv siab, ua tsis taus pa, hlwb pos huab, thiabdysautonomia suav nrog postural tachycardia syndrome (POTS). Kev tswj hwm ntawm POTS/dysautonomia feem ntau yog nyob raukev kawm, kev tawm dag zog, thiab ntsev thiab kua dej ntxiv.

Cov ntsiab lusPeb txoj kev nkag siab txog qhov cuam tshuam ntawm COVID-19 ntawm cov hlab plawv tau hloov mus tas li. Raws li peb nkag mus rau ib qho tshiablub hnub nyoog ntawm kev muaj sia nyob, kev tshawb fawb ntxiv yog xav tau los teev lub nra ntawm cov tsos mob ntawm lub plawv tsis tu ncua. Kev tshawb fawb yogkuj tseem yuav tsum tau kawm txog kev tswj hwm tus mob hnyav li cas tuaj yeem hloov pauv qhov tshwm sim thiab qhov tshwm sim ntawm tus mob no ntev.

Ntsiab lus:COVID-19. Kab mob plawv. SARS-CoV-2 . Rov qab mus ua si. Ntev COVID

Taw qhia

Xyoo 2020, tus kab mob Coronavirus 2019 (COVID-19)yog qhov thib peb ua rau tuag nrog kwv yees li 345,323tuag nyob rau teb chaws USA. Tej zaum ntau tshaj li lwm yam kev sib txuas luskab mob, COVID-19 tau ua rau mob plawvzej zog vim nws pom kev sib txuas nrog cov kab mob plawv(CVD). 

Qhov tshiab ntawm tus kab mob ua rau ntxovtso siab rau cov ntaub ntawv me me thiab cov lus piav qhia theoretical raupiav qhia thiab kwv yees qhov cuam tshuam rau CVD. Tam sim no, ntau tshaj ibxyoo txij thaum muaj kev sib kis's pib, kev kawm paub ntau dua muajtau tshwm sim uas kho peb txoj kev nkag siab ntawm kev sib cuam tshuam ntawmCOVID-19 thiab lub siab.Thaum ntxov ntawm kev sib kis, cov neeg mob uas muaj kab mob plawvua pov thawj feem ntau yooj yim rau kev kis mob hnyav. 

CovSpecification ntawm Severe Acute Respiratory SyndromeCoronavirus 2 (SARS-CoV-2) for the angiotensin-convertingenzyme-2 (ACE-2) protein ua rau muaj kev txhawj xeeb ntxivhais txog kev raug mob rau cov hlab plawvthiab ua rauKev ntshai ntawm kev siv tshuaj sib xyaw nrog rau angiotensin-hloov pauvenzyme inhibitors thiab angiotensin receptorblockers. Cov ntawv ceeb toom thaum ntxov tau piav qhia txog cov kab mob plawvkev tshwm sim ntawm tus kab mob COVID-19, suav nrogmyocarditis, kev nyuaj siab cardiomyopathy, myocardial infarction(MI), thiab arrhythmia. Hauv kev tawm tsam tus kab mob tshiab,lub zej zog cardiology tau siv nws cov cuab yeej tshaj plawssuav nrog lub plawv magnetic resonance imaging (CMR)uas muaj tus yam ntxwv mob thiab mob ntev ntawmSARS-CoV-2 infection, tab sis feem ntau cov kev tshawb pom muajtshuav cov kws kho mob uas muaj lus nug ntau dua li cov lus teb.Tam sim no ntau tshaj li ib xyoos txij li thawj kis tau tshwm sim hauv 2020,lub ntiaj teb cov zej zog pom nws tus kheej ntawm qhov tseem ceeb hauv qhovncua sijhawm ntawm kev sib kis. Nrog cov muaj sia nyob ntau dua covkis tau thiab nrog cov tshuaj tiv thaiv hauv kev faib khoom, kev saib xyuas ntxiv tuaj yeem ua tautau them rau cov kev mob plawv mus sij hawm ntev ntawm COVID-19.

Txawm li cas los xij, raws li kev nce ntxiv mus thoob ntiaj teb vim yogtshiab variants thiab ib tug lag nyob rau hauv cov tshuaj tiv thaiv kev faib tawm, kev kho mobzej zog yuav tsum nyob twj ywm apprised ntawm qhov tseeb pov thawj-raws likev tswj tus kab mob COVID-19 mob.Peb nkag siab txog qhov cuam tshuam ntawm COVID-19 ntawm lub plawvsystem yog evolving tas li. Lub nrawm nrawm ntawmtus kab mob kis thoob qhov txhia chaw thiab lub cev ntawm kev tshawb fawb nws tau spawned xav taucov kws kho mob kom hloov kev tswj hwm hauv lub sijhawm tiag tiag. Hauv no, peb tshuaj xyuascov ntaub ntawv tshiab kawg txog lub Plaub Hlis 1, 2022 los kho pebkev nkag siab tam sim no ntawm qhov mob hnyav thiab mus sij hawm ntevntawm COVID-19 kab mob ntawm lub plawv.

Hauv kev kis mob hnyav, peb rov mus saib peb qhov kev nkag siab tam sim nocov txheej txheem ntawm kev raug mob myocardial hauv COVID-19 kab mob,prognostic cuam tshuam ntawm troponin nce, thiab indicationsrau CMR hauv kev kuaj mob thiab kev tswj xyuas. Hauv kev daws teeb meemkis kab mob, peb tshuaj xyuas cov kev txiav txim siab rau cov neeg tshwj xeebxws li cov neeg ncaws pob hais txog kev nyab xeeb rov qab mus ua si, nrog rau covnrog lingering cov tsos mob cardiopulmonary colloquiallylub npe hu ua"ntev COVID." Peb xaus lus los ntawm kev thov yav tom ntejthaj chaw ntawm kev tshawb nrhiav rau kev sib cuam tshuam ntawm COVID-19thiab CVD.

Ntu I: Kab Mob Kab MobMechanisms of Cardiac Injury in COVID-19

Cardiac troponin yog ib qho kev ntsuam xyuas tshwj xeeb rau kev raug mob myocardial, uas tuaj yeem ntsuas los ntawm cov pa los yog siab-rhiab heevkev soj ntsuam. Qhov tseem ceeb, qhov siab troponin (txhais tau tias yog saum toj noqhov 99 feem pua ​​​​ntawm cov kev siv sab saud) tsis tas yuav tsum tausib npaug rau MI. Raws li 4th universal txhais, cov txheej txheem rau MI yuav tsum tau nce / poob qauv ntawm troponinnrog tsawg kawg ib tus nqi siab dua li 99 feem pua ​​​​nrognrog rau lwm cov tsos mob lossis cov tsos mob ntawm ischemia. Hom 1 MItshwm sim los ntawm ib qho mob plaque rupture / yaig tshwm sim, uas muajkuj tau pom nyob rau hauv qhov chaw ntawm lwm yam kab mob, hos hom 2 MI yog los ntawm"xav tau ischemia" nyob rau hauv cov ntsiab lusntawm qhov xav tau oxygen / muab khoom tsis sib haum los ntawmkev ntxhov siab xws li hypoxia, hypoperfusion, thiab tachycardia,uas tuaj yeem tshwm sim hauv COVID-19, nrog rau lwm yam mob hnyav. Ob hom MIs tau tshaj tawm hauv COVID-19. 

Txawm li cas los xij, paradoxically, muaj kwv yees li 20 feem puatxo qis hauv ST-elevation myocardial infarction (STEMI) tus nqithaum lub sij hawm COVID-19 kis thoob qhov txhia chaw. Lwm cov mechanisms tom qabqhov kev txo qis STEMI no tau raug tso tawm, tab sis yog thawjkev txhawj xeeb yog tias cov neeg mob tau zam kev saib xyuas hauv tsev kho mob kom ntshaintawm kev cog lus tus kab mob. Tshaj li mob MI, troponin ncetuaj yeem nrog rau lwm tus COVID-19 cov hlab plawvkev nthuav qhia suav nrog tus kab mob myocarditis, kev raug mob ntawm lub plawv tsis ncajlos ntawm cytokine cua daj cua dub, kev nyuaj siab cardiomyopathy, plawv tsis ua hauj lwm (HF),pulmonary embolism, thiab arrhythmias, los yog muaj kev cuam tshuam ua ntejCVD los yog lub plawv structural abnormalities. Qhov tshwm sim ntawm kev raug mob plawv, raws li ntsuas los ntawm qhov siabcardiac troponin, ntawm qhov kev txiav txim ntawm 20–40 feem pua ​​ntawm covthawj zaug tshaj tawm cov neeg mob uas mob hnyav (hauv tsev kho mob) COVID-19attracted cov xim ntawm cardiology thiab kev kho mob zej zogntawm loj. 

Raws li virology ntawmSARS-CoV-2 tau piav qhia ntxiv, nws cuam tshuam nrogACE2 protein pom ntawm cardiomyocytes txhawb nqa lub cevplausibility ntawm direct cardiac viral raug mob [7]. A precedenttau tsim los ntawm tus mob coronavirus, SARSCoV-1, ua rau thawj tus kab mob SARS tshwm sim hauv Asia, uas yogTus kab mob RNA hauv cov ntaub so ntswg tau raug cais tawm [26]. Tsis tas li ntawd, cov tib neeg uas muaj CVD, xws li cov kab mob coronary artery(CAD) thiab HF [27, 28], thiab cov uas muaj CVD muaj feem cuam tshuamsuav nrog ntshav siab, ntshav qab zib, thiab rog [27, 29–31] ua pov thawj ntau raug mob hnyav, ua rau muaj kev txhawj xeeb ntau ntxivtias lub siab yuav yog lub hom phiaj kis kab mob ncaj qha thiab ua tiavyooj yim dua yog tias muaj kev cuam tshuam.Nrog rau cov etiology ntawm myocardial raug mob nyob rau hauvCOVID-19, peb txoj kev nkag siab tau hloov zuj zus txij thaum pibntawm qhov tshwm sim. Cov kev tshawb fawb histopathologic loj dua tau sib twcov txheej txheem ntxov ntawm kev raug mob plawv, ua kom pomqhov tshwm sim ntawm myocarditis thiab direct viral toxicity raumyocytes yuav tsum tsis tshua muaj heev. Hauv ib qho ntawmloj tshaj plaws mob plawv autopsy series rau hnub tim, Lindner thiab cov npoj yaigqhia tau hais tias thaum tus kab mob RNA raug cais tawm hauv plawvcov ntaub so ntswg, nyob rau hauv situ hybridization localized qhov chaw ntawm tus kab mob tsisrau cardiomyocytes, tab sis theej interstitium thiab infiltratingmacrophages. Tsis tas li ntawd, muaj pes tsawg tau lees paubmob myocarditis los ntawm Dallas cov txheej txheem. Lwm yam pathologycov kev tshawb fawb kuj tseem ua tsis tau tej ntaub ntawv ncaj qha cardiomyocytekab mob. 

Qhov tseem ceeb, raws li cov yam ntxwv ntawm tus mob coronavirus tshiab tau nrawm heevcataloged thaum ntxov ntawm kev sib kis, me me tau ua los sib pivtawm tsam cov pab pawg tswj kom tsim nyog. Kev tshawb fawb tsis ntev los no tau nyobCOVID-19 nyob rau hauv cov ntsiab lus ntawm kev saib xyuas qhov tseem ceebtoj roob hauv pes. Metkus thiab cov npoj yaig piv rau troponin ncehauv COVID-19 mob ua pa nyuaj siab(ARDS) piv rau tsis yog-COVID-19 ARDS ntawm ze li 250 intubated cov neeg mob thoob plaws lub tsev kho mob loj thiab ua qauv qhiatias myocardial raug mob tiag tiagtsawgcommon nyob rau hauvCOVID-19 tshaj qhov tsis yog-COVID-19 ARDS, tom qab tso nyiaj rauqib ntawm kev mob hnyav thiab lub cev tsis ua haujlwm. Cov neeg mob nrog COVID-19 muaj oxygenation thiab hemodynamics tsis zoo, txhawb indirect cardiac raug mob thib ob rau tseem ceebmob raws li qhov feem ntau yuav mechanism ntawm kev ua si. Cov noCov kev tshawb pom tau ntxiv dag zog ntxiv los ntawm cov qib siab ntawm myocardialkev raug mob pom nyob rau hauv lwm yam kab mob kis dhau ntawm COVID-19,suav nrog sepsis, sau tseg hauv cov ntaub ntawv kho mob tseem ceeb. Thaum lwm yam kev mob plawv xws li myocarditis,Kev nyuaj siab cardiomyopathy, thiab MI tau piav qhia hauvCOVID-19 thiab yuav tsum tsis txhob raug txo nqi, nyobCOVID-19 nyob rau hauv cov ntsiab lus ntawm lwm yam mob tseem ceeb muajrecalibrated peb to taub txog kev raug mob myocardial kom paubntau dua cov txheej txheem xws li hypoxemia thiab hemodynamickev sib haum xeeb (Fig.1). Txawm hais tias kev raug mob myocardial hauv COVID-19 yuav tsis yogtshwj xeeb rau tus kab mob, qib ntawm kev mob hnyav uas nws tuaj yeem ua tauua rau hais lus rau nws tus yam ntxwv pathogenic.

Lub luag haujlwmmechanism yuav muaj feem xyuam rau nws lub peev xwm los txhawb lub zoginflammatory teb. Hauv kev tshawb fawb txog kev raug mob myocardial hauvCOVID-19, tus kwv yees ntawm qhov siab ntawm troponin tau pom tsis tu ncuakev koom tes nrog inflammatory markers, nrog rauC-reactive protein (CRP),D-dimer, ferritin, thiab fibrinogen. Cov kev tshawb fawb pathology tau txhawb qhov nokev sib raug zoo los ntawm kev qhia ntau dua ntawm cytokinesnrog cov kab mob ntau dua. Thaum hyper-inflammatoryPhase inflics ntau ntawm cov pa thiab circulatory compromisemediating indirect myocardial raug mob nyob rau hauv mob hnyav,o yav tas los paub tias ncaj qha kho CVD,Raws li pom nyob rau hauv atherosclerosis thiab lwm yam hyper-inflammatory xeevsuav nrog sepsis thiab hemophagocytic lymphohistiocytosis(HLH). Cardiomyocytes qhia receptors rau cytokinessuav nrog qog nqaij hlav necrosis thiab interleukin -6, cov teebmeemntawm uas tuaj yeem txo qis inotropy theem nrab rau kev hloov pauv hauv catecholaminetaw qhia thiab ua rau raug mob cytotoxic. 

Ntxiv mus, cytokines hloov cov vascular endothelium los txhawbinflammatory migration thiab tuaj yeem ua rau endothelitis,microthrombi, thiab microvascular raug mob uas tau piav qhiahauv COVID-19. Echocardiography tau ua kom zoo dua peb txoj kev nkag siab ntawmmyocardial puas tsuaj hauv COVID-19, qhia txog qee yam kev ua haujlwmcov qauv ntawm kev raug mob. Szekely thiab cov npoj yaig pom txoj caiventricular (RV) dysfunction yog qhov feem ntau echocardiographicabnormality nyob rau hauv ib tug series ntawm 100 nyob rau hauv tsev kho mobCov neeg mob COVID-19, ntawm ze li ntawm 40 feem pua, nrog RV deteriorationfeem ntau cuam tshuam nrog kev kho mob decompensations. RVdysfunction kuj yog qhov feem ntau txawv txav pom nyob rau hauv ibmulti-center thoob ntiaj teb pawg ntawm ntau dua 300 tus neeg mob hauv tsev kho mobnrog COVID-19, nyob ib ncig ntawm 26 feem pua. Ib tug tag nrho spectrum ntawmkev ua haujlwm tsis zoo tau pom hauv ob qho kev tshawb fawb, txawm li cas los xij, suav nrogNtiaj teb no thiab lub regional sab laug ventricular (LV) systolic dysfunctiondiastolic dysfunction, thiab pericardial effusions. Qhov ntauntawm RV dysfunction hais lus rau COVID-19 ua ntej ua ntejua pa pathogen nrog ib tug nyiam mus tobvenous thrombosis thiab pulmonary embolism, tag nrho cov notuaj yeem cuam tshuam pulmonary vascular tsis kam thiab nceRV loading tej yam kev mob. Kev siv cov speckle-tracking echocardiography pom txo qis basal longitudinal strain kom muaj nyob rau hauv52 feem pua ​​​​ntawm cov neeg mob nyob rau hauv ib qho kev kawm ib leeg; cov neeg mob uas yogCov neeg rog rog, Cov Neeg Dub, lossis cov neeg mob ntshav siab thiab ntshav qab zibmuaj feem ntau yuav nthuav tawm nrog cov qauv ua haujlwm no. Cov kev tshawb fawb yav tom ntej yog xav tau los txiav txim seb cov noCov kev hloov pauv ua haujlwm yog tshwj xeeb rau COVID-19 lossis tseem pom hauvLwm hom ARDS thiab mob hnyav.

Troponin Elevation: Prognostic Implications

Mechanism ntawm kev raug mob ib sab, kuaj pom troponin ncemuaj tus nqi kwv yees nyob rau hauv tus kab mob COVID-19 mob. Shithiab cov npoj yaig yog thawj tus tshaj tawm txog kev tuag ntau duanyob rau hauv cov neeg uas muaj troponin nce los ntawm ib tug ib-center cohort nyob rau hauvWuhan, nrhiav tau peb npaug rau plaub npaug kev pheej hmoo ntawm kev tuag. Tom qab ntawd, Lombardi thiab cov npoj yaig tau lees paub cov kev tshawb pom no hauv amulti-center cohort hauv Ltalis nrog ntau dua 600 tus neeg mob, txawm tias nrogib tug ntau attenuated txaus ntshai piv ntawm 1.7. Hauv ib qho ntawm feem ntauCov neeg sib txawv tau kawm nrog ntau dua 2000 tus neeg mob nkag mus rau aNew York City tsev kho mob system, Smilowitz thiab cov npoj yaigpiav qhia tias qhov kev pheej hmoo ntawm kev tuag yog ob npaug ntau dua ntawmCov neeg mob uas muaj troponin nce. Qhov tseem ceeb, degreeQhov siab ntawm troponin tau cuam tshuam nrog qhov hnyav duamob (txhais tau tias yog kev nkag mus rau ICU, xav tau kev siv tshuab ua pa, tawm mus tsev kho mob, lossis tuag). Thaum cov lus qhuab qhia noCov kev tshawb fawb txhais tau tias troponin nce siab dua li 99thfeem pua ​​​​ntawm cov kev txwv sab sauv ntawm ib txwm, Qin thiab cov npoj yaigpiav qhia tias kev nce qib troponin hauv COVID-19 tus kab mobtau cuam tshuam nrog kev tuag txawm tias nyob rau theem 19–50 feem pua ​​qiser dua li cov kev lig kev cai siv hauv chaw kho mob. 

Tsis tas li ntawd, kev pheej hmoo rau kev tuag thiab qhov tshwm sim tsis zoo tshwm simtxuas ntxiv nrog rau qib ntawm troponin nce; siab dua troponintxuas ntxiv ua kom muaj kev pheej hmoo, muab cov kws kho mob nrog aquantitative tsis yog qhov kev ntsuam xyuas zoo rau cov neeg mob. Xws li, ntsuas troponin rau tsev kho mob COVID-19 tus neeg mob tau koom ua ke rau hauv kev kho mob niaj hnubthiab tswj algorithms. Rau tsev kho mob, nws ua haujlwm rau kev kwv yeestrajectory thiab txheeb xyuas cov neeg mob uas yuav xav tau ntau duakev siv nyiaj ntau heev, tshwj xeeb yog thaum muaj kev tsis txaus. Ntau lub zej zog cov txheej txheem suav nrog World HealthLub koom haum thiab Tuam Tshoj Clinical Guide rauCOVID-19 pom zoo ntsuas troponin rau txhua tus neeg tau txaiscov neeg mob, thaum lwm tus suav nrog American College ofCardiology (ACC) pom zoo kom kuaj thaum kho mob [22]. Kev sib koom ua ke ntawm troponin nce siab thiab kev tuagspurred kev sib cav txog seb qhov kev raug mob myocardial puas yog tus neeg nruab nrab lossis atus cim ntawm qhov tshwm sim tsis zoo. Hauv lawv qhov sib piv ntawmCOVID thiab tsis yog-COVID ARDS, Metkus thiab cov npoj yaigqhia tau hais tias kev nce qib troponin tsis cuam tshuam lawmnrog kev tuag tom qab tswj tau lub hnub nyoog, poj niam txiv neej, thiab, qhov tseem ceeb,multiorgan system tsis ua hauj lwm. Tsis tas li ntawd, Giustinothiab cov npoj yaig tau hais tias muaj troponinKev nce siab ib leeg yuav tsis hnov ​​​​qab txaus los kuaj xyuasmuaj txiaj ntsig myocardial raug mob [44]. Hauv kev rov qab los,multi-center thoob ntiaj teb kev tshawb fawb ntawm echocardiographic tshawb pomhauv ntau dua 300 tus neeg mob pw hauv tsev kho mob nrog COVID-19, tsuas yog cov ntawdnrog troponin nce siab thiab echocardiographic txawv txav,Tsis yog troponin nce ib leeg, muaj kev pheej hmoo siab duakev tuag hauv tsev kho mob [44]. Cov kev tshawb pom no qhia tias myocardialKev raug mob pov thawj los ntawm kev kuaj pom troponin, zoo li lwm yamCov cim suav nrog lactate, creatinine, thiab bilirubin, feem ntau yogqhov tshwm sim, tsis yog qhov ua rau, mob hnyav thiab cuam tshuamqhov frailty ntawm lub hauv paus substrate.

Lub luag haujlwm ntawm Cardiac Magnetic Resonance Imaging

Cov kab mob physiologic plausibility ntawm COVID-19 ua rau ncaj qhaCov kab mob myocardial thiab cov ntaub ntawv hais txog qhov tshwm sim thaum ntxovmyocarditis ua rau muaj kev txaus siab rau kev siv CMR, tam sim no lubQhov kev xaiv zoo tshaj plaws uas tsis yog-tus kab mob kuaj mob rau tus mob myocarditis [49]. Thawj rooj plaub qhia txog myocarditis nyob rau hauv mobTus kab mob COVID-19 tau tshaj tawm txog li 7 feem pua; Txawm li cas los xij, cov kev tshawb fawb no tau ua txhaum los ntawm kev kuaj mob tsis sib xwscov txheej txheem thiab txwv cov qauv loj. Raws li tau tham dhau losnyob rau hauv cov ntsiab lus ntawm histopathologic kev tshawb fawb, qhov prevalencentawm myocarditis hauv COVID-19 tam sim no tau txais txiaj ntsig zoo heevtsis tshua muaj, thiab loj dua rov qab los ntawm ntau qhov chaw sib koom ua ketau pom tias nws yog 1 feem pua ​​lossis tsawg dua. Paub qhov qisua ntej kuaj qhov tshwm sim ntawm COVID-19 myocarditis thiab xav txoguas feem ntau yuav ua rau mob myocardial raug mob qhia qhov tsim nyogsiv CMR. Tshwj xeeb nrog CMR, qhov ntev dualub sijhawm kuaj thiab logistics yuav tsum tau ua kom haumkev kuaj mob hauv cov neeg mob intubated (nrog rau cov neeg mob hloov pauvmus rau thiab los ntawm cov tshuab ua pa uas muaj kev nyab xeeb) ua rau muaj kev pheej hmoo ntau ntxivrau cov neeg ua haujlwm kho mob. 

Tom qab ntawd, zej zog cov txheej txheem rau kev siv tsim nyogCMR thaum kis tus kab mob COVID-19 tau hais txog qhov kev txiav txim siabntawm lwm txoj kev kuaj mob thiab pom zoo siv nkaus xwbthaum nrhiav tau yuav hloov kev tswj. Lub Society ofCardiovascular Magnetic Resonance (SCMR) pom zoo rauKev siv CMR hauv kev kis tus kab mob COVID-19 thaum cov txiaj ntsig tau saiCov txheej txheem cuam tshuam, suav nrog tab sis tsis txwv rau revascularization, valvular interventions, tsim nyog ablations,immunosuppression, los yog kev txhawj xeeb rau malignancy yuav tsum tau cardiothoracicphais [54]. Thaum tshiab LV dysfunction los yog chaw kho mobCov tsos mob (xws li, mob hauv siab, arrhythmia) ua rau muaj kev txhawj xeebmyocarditis, ib pawg kws tshaj lij los ntawm ACC pom zooCMR tsuas yog tom qab CAD tau txiav txim siab los ntawm angiography lossistsawg invasive modalities xws li coronary xamtomography angiography (CCTA), vim tias qhov ua ntej kuaj qhov tshwm simntawm ischemia feem ntau yuav ntau dua li mob myocarditis[55•] Tej zaum yuav muaj kev txaus siab ntau dua hauv CMR rau kev soj ntsuamntawm cov muaj sia nyob tom qab kis mob hnyav. Huang thiab cov npoj yaigyog thawj zaug ua kom pom myocardial edema thiabfibrosis, pov thawj los ntawm qhov txawv txav T1 / T2 signaling thiab lig gadoliniumkev txhim kho (LGE), feem, hauv ib qho qauv me mentawm 26 tus neeg mob uas txuas ntxiv qhia cov tsos mob plawv 50hnub los ntawm cov tsos mob pib [56]. Tom qab ntawd, nyob rau hauv ib tug yav tom ntej cohortkev tshawb fawb ntawm 100 tus neeg mob tsis tau xaiv (piv txwv li, tsis tas yuav tuajnrog cov tsos mob plawv), Puntmann thiab cov npoj yaig tau qhiaKev mob myocardial tsis tu ncua hauv 60 feem pua ​​​​ntawm cov neeg mobntawm qhov nruab nrab ua raws li 71 hnub [13]. Cov kev tshawb pom notsa lub tswb rau lub sijhawm ntev rau cov pej xeem(ntawm kev ceeb toom, ob feem peb ntawm cov neeg koom tsis tau pw hauv tsev kho mob) thiab xaiv cov tib neeg, xws li ncaws pob, los uatshawb nrhiav hauv seem tom ntej. Qhov tseem ceeb, cov kev tshawb fawb notsis tau tshuaj xyuas cov txiaj ntsig kho mob ntsig txog cov kev tshawb pom nouas tseem yog thaj chaw tseem ceeb ntawm kev tshawb nrhiav. Ntxiv mus,yuav tsum tau ua hauj lwm ntxiv los sib piv kev raug mob myocardial tom qabTus kab mob COVID-19 nrog kev tswj hwm tshaj li cov neeg noj qab haus huv, vim hais tias cov kev tshawb pom zoo sib xws CMR tau piav qhiatom qab lwm yam kab mob sib kis xws li sepsis [57]. Cov lus pom zoo rau CMR hauv kev kis tus kabmob COVID-19 tau sau tseghauv Fig.2.

Ntu II: Kev daws teeb meem kab mobCOVID-19 thiab Rov qab mus ua si rau cov kis las

Cov lus nug txog thaum twg tus neeg ncaws pob sib tw tuaj yeem rov qab mus ua si(RTP) tom qab tus kab mob COVID-19 ua rau muaj xwm txheej ceev thiab tsis tsim nyogtant kev sib tw rau lub teb ntawm cardiology. Qhov ceev yog tsavlos ntawm qhov tseeb tias cov koom haum kis las, los ntawm cov kws tshaj lij raukev ua si, yog qee qhov thawj zaug rov qab mus rau qhov nrawmthaum muaj kev sib kis. Qhov kev sib sau ua ke rov qab los pib nrogcov ntaub ntawv me me txog yuav ua li cas thiaj li muaj kev nyab xeeb tom qab kis kab mob. Qhov tseem ceebtau meej, raws li myocarditis yog ib tug muaj peev xwm sequela ntawmTus kab mob COVID-19 thiab ua rau muaj kev tuag ntawm cov tub ntxhais hluas ncaws pob[58]. Kev tawm dag zog nrog myocarditis nquag tuaj yeem ua rau muaj zog ntxivo thiab arrhythmogenic milieu.Tsis tas li ntawd, lub plawv kis las tuaj yeem muaj qhov txawv txav ntawm qhov loj,ua haujlwm, thiab teb rau kev tawm dag zog uas ua rau nws nyuaj raupaub qhov txawv ntawm lub plawv mob los yog raug mob [59]. khausKev tawm dag zog tuaj yeem ua rau muaj kev nce siab nyob rau hauv troponins thiab duabCov kev tshawb pom qhia tias mob plawv qaug zog thiab myocardialmob [60]. Nrog ntau txhiab tus neeg ncaws pob xav rov qab losrau kev nqis tes ua, yuav ua li cas thiaj li muaj kev nyab xeeb los ua qhov teeb meem tseem ceeb hauv lubdaim teb ntawm cardiology thoob plaws hauv kev sib kis.

Lub Tsib Hlis 2020, ACC's Kev Ua Si thiab Kev Ua SiCardiology Section muab nws thawj txheej ntawm RTPcov lus pom zoo [61]. Rau cov neeg ncaws pob uas tau ntsib cov tsos mobkab mob, lawv tau pom zoo rau 2-lub lim tiam soTom qab cov tsos mob daws teeb meem, kev ntsuam xyuas plawv (electrocardiogram, echocardiogram, lossis siab troponin),thiab ntxiv daim duab plawv nrog tej yam txawv txav. Yogkuaj pom myocarditis, cov kws kho mob tau raug xa mus rau cov uas twb muaj lawmAmerican Heart Association (AHA) / ACC myocarditis cov lus qhiauas pom zoo kom tsis txhob kis las rau 3–6 hli [62]. Rau lub hlis tom qab, Tshooj lus hloov kho thiab nthuav davcov txheej txheem no suav nrog cov lus pom zoo tshwj xeebraws li hnub nyoog thiab cov ncauj lus kom ntxaws troponin thiab CMR tshuaj xyuas cov lus pom zoo [63]. Ib Daim Ntawv Pom Zoo Pom Zoo Ua raws lied, ob qho tib si uas tau pom zoo tawm tsam kev siv CMR-raws litshuaj xyuas txhua tus neeg ncaws pob uas muaj tus kab mob COVID-19 ua ntej[64]. 

Kev siv CMR hauv RTP qhov chaw tau txais ntau attenkev. Tshaj tawm rau lub Cuaj Hlis 2020, Rajpal thiab cov npoj yaigua CMR hauv 26 tus neeg sib tw ncaws pob thiab pom tias 4(15 feem pua) muaj CMR kev tshawb pom qhia txog myocarditis, thiab 8Cov neeg ncaws pob ntxiv (30.8 feem pua) tau nthuav tawm LGE yam tsis muaj T2 nceqhia txog kev raug mob myocardial ua ntej [65]. Brito thiab cov npoj yaigTom qab ntawd luam tawm ib qho kev tshawb fawb txog kev tshawb pom (echocardiographythiab CMR) ntawm 54 tus tub-ntxhais ncaws pob uas tau rov zoolos ntawm tus kab mob COVID-19 [66]. Lawv xaus li ntawdntau tshaj 1 ntawm 3 tus neeg ncaws pob hauv tsev kawm qib siab yav dhau los noj qab nyob zooing los ntawm tus kab mob COVID-19 tau pom cov duab thaij duab ntawmdaws cov kab mob pericardial.

Cov kev tshawb fawb no txwvnyob rau hauv lawv qhov loj thiab tsis muaj pawg tswj hwm lossis cov chaw kho mob kawg,tab sis lawv tau tsa lub tswb ntxiv rau RTP kev nyab xeeb, tshwj xeeb ntawmqib kawm qib siab.Hmoov zoo, cov ntaub ntawv sau npe tsis ntev los no qhia txog lub tebchawsRTP tau ua haujlwm nyab xeeb. Kev kawm ntawm 789 tus kws tshaj lijCov neeg ncaws pob uas tau ua tiav RTP daim ntawv kuaj mob plawv tom qabTus kab mob COVID-19 pom cov duab pov thawj ntawm qhov mobkab mob plawv hauv 5 tus neeg ncaws pob (0.6 feem pua) [67••]. Kev kuaj mob plawvCov txheej txheem suav nrog troponin, ECG, thiab transthoracic echocardiogram; CMR lossis kev ntxhov siab echocardiography tau ua rawstsuas yog nyob rau hauv cov neeg ncaws pob nrog qhov txawv txav ntawm kev kuaj mob plawv.

Tsis muajCov xwm txheej tsis zoo ntawm lub plawv tau tshwm sim hauv cov neeg ncaws pob uas tau ua tiavkuaj mob plawv thiab rov qab mus ua si.Qhia tus neeg mob los ntawm kev rov qab mus rau kis las tom qab aTus kab mob COVID-19 yog ib txoj kev nyuaj. COVID-19 dataevolves sai heev, kev ua si cardiology yog ib qho kev ua haujlwm zoo,thiab lub plawv kis las yog ib qho tshwj xeeb substrate. Qhov no ua ke rautsim kev tsis paub meej ntau dua li cov lus teb meej thaum mus txogrov qab mus ua si. Txawm li cas los xij, raws li lub sijhawm dhau musthiab ntau cov ntaub ntawv tshwm sim, uas rov qab los, thaum coj los ntawm qhov tam sim nokev tshuaj xyuas cov lus pom zoo, tuaj yeem ua tau zoo.

Ntev COVID

Raws li cov neeg ua haujlwm kho mob thiab cov kws tshawb fawb txuas ntxiv mus kawm,triage, thiab kho qhov mob plawv txaus ntshai ntawm COVID-19,ntau tus kws kho mob sab nraud tau raug dej nyab los ntawm cov neeg mobnrog cov tsos mob tsis tu ncua tom qab kis mob hnyav, paub hauv cov neeg nyiammedia uas"ntev COVID" [68]. Nrog kev paub ntau dua ntawmtus mob tsis tu ncua no, cov kws tshawb fawb tau tsim cov hauv qab nolus txhais:Post-acute COVID Syndrome (PACS)raucov tsos mob tsis tu ncua tom qab 3 lub lis piam thiabchronic COVIDtom qab12 lub lis piam [69, 70]. National Institutes of Health kuj muajxa mus rau"ntev COVID" raws lipost-acute sequelae ntawm SARS-CoV-2 infection (PASC)[71]. 

Cov tsos mob qhia tau hais txog aloj dav ntawm cardiopulmonary thiab neurologic tsis txaus siabnrog rau qaug zog, palpitations, mob hauv siab, ua tsis taus pa,lub hlwb pos huab, thiab dysautonomia. Cov kws tshawb fawb tau kawm txog qhov cuam tshuam tsis tu ncua ntawmCOVID-19 txij li hnub pib muaj kev sib kis. Ntawm ib pawgntawm 143 tus neeg mob tso tawm hauv tebchaws Ltalis txij lub Plaub Hlis 2020, 87 feem puaqhia txog kev qaug zog thiab ua tsis taus pa ntawm 60 hnub. Halpin thiab cov npoj yaig hauv tebchaws United Kingdom (UK) ua qauv qhiauas cov neeg mob xav tau kev kho mob hnyav–qib tumuaj feem ntau dua li cov neeg mob hauv pawg ntseeg kom tshaj tawm tsis tu ncuaCov tsos mob ntawm qaug zog (72 feem pua ​​​​vim 60.3 feem pua) thiab ua tsis taus pa(65.6 feem pua ​​vs 42.6 feem pua) tom qab tso tawm.

Lwm qhov loj duacohort hauv Michigan pom tias 159 ntawm 488 (33 feem pua) cov neeg mob pom zoocov tsos mob ntawm cardiopulmonary tsis tu ncua nrog rau hnoosthiab dyspnea ntawm 60 hnub. Txoj kev tshawb no tau txwv los ntawm acoob tus neeg mob (ntau dua 50 feem pua) tau ploj mus rau kev soj ntsuam. Thaum cov kev tshawb fawb thaum ntxov tau kwv yees qhov ntau ntawm qhov ntevCOVID kom nyob nruab nrab ntawm 30 thiab 80 feem pua, lawv raug txwv los ntawm iblub hom phiaj tseem ceeb ntawm cov neeg mob hauv tsev kho mob. Hauv qhov tsis muajnyob hauv tsev kho mob pawg ntawm 272 tus neeg thoob plaws Tebchaws Meskas, 35 feem puaqhia tias tsis yog nyob rau hauv lub hauv paus ntawm 14–21 hnub tom qab COVID-19kuaj mob. Cov kev tshawb fawb tshiab tau siv cov thev naus laus zis mobile rautso cai rau cov neeg teb tuaj saib xyuas thiab tshaj tawm lawv cov tsos mobrau ob qho tib si mob thiab ntev mus taug qab cov tsos mob. Thaum cov neeg laus uas muaj ntau yam sib txawv nyob ntawmKev pheej hmoo siab dua ntawm COVID ntev, kwv yees li 20 feem pua ​​​​ntawm cov tub ntxhais hluascov neeg, hnub nyoog 18 xyoo–34 thiab tsis muaj kev mob tshwm sim,tseem tau tshaj tawm cov tsos mob tsis tu ncua ntawm 14–21 hnub. 

Hais txog cov tsos mob ntawm cov hlab plawv, kwv yees li20 feem pua ​​​​ntawm cov tib neeg qhia mob hauv siab thiab 14 feem pua ​​​​tau qhiapalpitations ntawm 60 hnub. Inflamation thiab nceKev xav tau metabolic thiab myocardial xav tau los pabrau cov tsos mob plawv tsis tu ncua raws li qhov no tau uapom nyob rau hauv lwm cov kab mob coronavirus hnyav xws li SARS. Ntau tus neeg mob thiab cov ntaub ntawv tshawb fawb tau nce ntxiv

Daim duab 3Kev tshuaj xyuas ntawm qhov muaj ntauntawm ntev COVID, txhais thiabcov tsos mob tshwm sim, thiabtam sim no cov ntsiab cai ntawm kev tswjrau qhov muaj peev xwm COVID/kev coj tus cwj pwmorthostatic tachycardia syndromesib tshooj

Daim duab 4Cov lus pom zoo rau yav tom ntej ntawm kev tshawb nrhiav hauv thaj chaw tshawb fawb hauv qhov kev tshuaj xyuas no. Cov ntawv luv: POTS postural orthostatic tachycardiaSyndrome, CMR cardiac magnetic resonance

Kev raug mob myocardial hauv COVID-19 zoo li feem ntaukho mob los ntawm qhov mob hnyav heev es tsis yog raug mob ncaj qhamus rau myocardium los ntawm cov kab mob kis. Thaum mob myocardial raug mobtsis tshwj xeeb rau COVID-19 thiab pom lwm qhov hauv kev saib xyuas hnyavCov ntaub ntawv hauv sepsis thiab ARDS, cov lus teb hyper-inflammatorynag los los ntawm COVID-19 yog ib qho cim tshwj xeeb thiab tuaj yeem kho taucov chav kho mob hnyav dua pom zoo li piv nrog rau lwm yamkab mob. Yog tias muaj dab tsi, COVID-19 tau txhawb nqa qhov kev cuam tshuam tseem ceebnruab nrab ntawm o thiab CVD thiab yuav tsum spur yav tom ntejua haujlwm hauv daim teb no. Thaum mob myocardial nyob rau hauv daim ntawv ntawm troponinKev nce siab yog nthuav dav thiab muaj kev soj ntsuam hauv tus mob COVID-19Kev kis kab mob, cov kev tshawb fawb tsis ntev los no qhia tias kev nce qib troponin yog qhov cimntawm tus kab mob hnyav thiab lub hauv paus substrate, tsis yog ib qhoywj siab mediator ntawm cov txiaj ntsig.

Thaum CMR tseem yog lub cuab yeej muaj zog rau kev kuaj mob hnyavmyocarditis, nws yuav tsum tau siv judiciously nyob rau hauv lub teeb ntawm qhov tsawgLub hauv paus nthuav dav tau tsim nyob rau hauv cov kev tshawb fawb txog niaj hnub no, nrog rau kev pheej hmookev raug rau cov neeg ua haujlwm kho mob. Kev kawm yuav tsum tau nkag siabqhov chaw kho mob tseem ceeb ntawm cov teeb meem inflammatory tsis tu ncuapom nyob rau hauv cov ciaj sia thiab yuav ua li cas qhov no yuav piv los yog sib piv nrogcov uas rov zoo los ntawm lwm cov kab mob uas tshwm sim los yog mob hnyav.CMR tej zaum yuav muaj lub luag haujlwm tsom mus rau kev muab cov lus pom zoorau cov neeg muaj kev pheej hmoo xws li ncaws pob; txawm li cas los xij, nws yuav tsumtsis tshua muaj thawj-kab modality thiab cov duab pom ib leegyuav tsum tsis txhob ua lub hauv paus rau kev kuaj mob myocarditis.

Thaum kawg, thaum peb nkag mus rau lub hnub nyoog tshiab ntawm kev muaj sia nyob, ntxivkev tshawb fawb yog xav tau los catalog lub nra ntawm kev pheej hmoocardiopulmonary cov tsos mob uas muaj qhov cuam tshuam tseem ceebrau cov neeg mob noj qab haus huv thiab kev lag luam thoob ntiaj teb hais txog qhovmuaj peev xwm rov qab mus ua haujlwm. Kev tshawb fawb kuj tseem xav tau kom paub meejseb puas muaj kev kho mob rau dysautonomia nrog rau POTSmuaj txiaj ntsig zoo rau cov pej xeem COVID ntev, thiab mob hnyav npaum li caskev tswj hwm tuaj yeem hloov qhov yuav tshwm sim thiab qhov muaj ntau ntawm qhov nomob mob syndrome. Yav tom ntej thaj chaw ntawm kev tshawb nrhiav thoob plawscov chaw tshawb nrhiav hauv qhov kev tshuaj xyuas no tau piav qhia hauv Fig.4. 

Thaum cov lus nug tseem nyob thiab tseem yuav tshwm sim ntxiv txogCOVID-19 thiab CVD, kev kis thoob qhov txhia chaw tau ua pov thawj tiaslub zej zog scientific yog tshwj xeeb cog lus thiab muaj peev xwmntawm muab cov lus teb tseem ceeb no.

Nrhiav qhov zoo tshaj plaws BOTANICAL HOLISTIC CARE los txhim kho koj txoj kev tiv thaiv kab mob

Peb ua tib zoo xuas tes ua Neuro Regen cov mis muaj xws li tshuaj ntsuab tshawb fawb zoo tshaj plaws. qhia tau hais tias amazing muaj peev xwm tiv thaiv kev puas tsuaj los ntawmCOVID, plus generalIMMUNEthiab neuron txhawb nqa hauv qab no.

Xws li:

Tus Vaj Ntxwv ntawm Immunity Boost-Cistanche

1. Cov khoom xyaw tseem ceeb ntawm Cistanche

Cistanche phenethanol glycosides yog muab rho tawm los ntawm Xinjiangcistanche, thiab lwm yam kev tshawb fawb tau ntse cais ntau yamphenethanol glycosides, feem ntau suav nrogechinacoside cov tshuajthiablus verbascoside.

2. Lub tshuab ntawm Cistanche rau kev txhim kho kev tiv thaiv

• Cistanchepolysaccharidestuaj yeem txhawb kev loj hlob ntawm T lymphocytes thiab B lymphocytes, tab sis kev loj hlob ntawm B lymphocytes yog qhov muaj zog dua li ntawm T lymphocytes.

• Cistanche polysaccharidetxhawb kev tso tawm ntawm cytokine IL22 los ntawm lymphocytes, uas cuam tshuam rau kev txhawb nqa ntawm splenic lymphocyte proliferation.

• Cistanche tuaj yeem qhib cov macrophages thiab tswj lub cev tiv thaiv kab mob.

• Cistanche polysaccharide,echinacoside,thiablus verbascosidemuaj cov teebmeem tseem ceeb ntawm kev tsim thiab kev ua haujlwm ntawm tib neeg lymphocytes. Nws tuaj yeem ua kom cov lus teb loj hlob ntawm lymphocytes, yog litxhim kho lub cev tiv thaiv kab mob.

• Cov khoom siv ua haujlwm ntawm Cistanche tag nrho glycosides muaj cov txiaj ntsig tseem ceeb ntawm kev rov ua haujlwm ntawm tes tom qab 60Coy hluav taws xob puas tsuaj, thiab tuaj yeem txhim kho lub cev tsis muaj zog tiv thaiv hluav taws xob puas tsuaj.

•