Cardiovascular complications associated with SARS-CoV-2 infection. Systematic Review

• María Vásquez-Guillén Universidad de Los Andes. Facultad de Medicina. Departamento de Microbiología. Mérida-Mérida. Venezuela https://orcid.org/0000-0002-0754-3986
• Andrea Vásquez-Guillén Universidad de Los Andes. Facultad de Medicina. Departamento de Microbiología. Mérida-Mérida. Venezuela https://orcid.org/0000-0001-7414-2317
• Javier Alejandro Inglessis-Aguilar Instituto Autónomo Hospital Universitario de Los Andes. Servicio Cardiología. Mérida-Mérida. Venezuela https://orcid.org/0000-0002-1989-6359
• Mike Contreras Universidad Federal de Goiás. Campus Colemar Natal e Silva. Instituto de Patologia Tropical e Saúde Publica. Área de imunologia. Goiânia-Goiás. Brasil https://orcid.org/0000-0001-9899-5306
• Yenddy Carrero Universidad Técnica de Ambato. Facultad de Ciencias de la Salud. Carrera de Medicina. Campus Ingahurco. Ambato-Tungurahua. Ecuador http://orcid.org/0000-0003-4050-4468

DOI: https://doi.org/10.56903/kasmera.5137658

Keywords: COVID-19, SARS-CoV-2, complications, myocarditis, coagulation

Abstract

The COVID-19 disease has affected the entire world, becoming one of the worst pandemics of our generation, as well as being a great social and health challenge. This mainly affects the respiratory system, however, studies have shown that it compromises the cardiovascular system, which has generated a big concern, since this would imply greater vulnerability in patients with underlying cardiovascular pathologies, which represent a significant percentage of the population. Furthermore, the presence of comorbidities, such as hypertension, diabetes, and coronary artery disease, has been shown to be associated with higher mortality rates. This not only affects chronic cardiovascular patients, but it can also cause cardiovascular alterations in patients without a history of cardiovascular disease, so it is necessary to monitor cardiac biomarkers in these patients for a better approach in their development. Clinical studies have shown that the cardiovascular pathologies associated with COVID-19 are heart failure, myopericarditis, cardiogenic shock, acute cardiac injury, coagulation and thrombosis disorders, arrhythmias, acute coronary syndrome, and Kawasaki disease. This study is based on a comprehensive review of complications associated with COVID-19 and its possible mechanisms of action, for a better understanding of medical and health personnel (PROSPERO ID 316364)

References

Coronavirus (COVID-19) - Google Noticias [Internet]. 2020. Disponible en: https://news.google.com/covid19/map?hl=es-419&gl=US&ceid=US%3Aes-419

López-Ponce de León JD, Cárdenas-Marín PA, Giraldo-González GC, Herrera-Escandón Á. Coronavirus - COVID 19: Más allá de la enfermedad pulmonar, qué es y qué sabemos del vínculo con el sistema cardiovascular. Rev Colomb Cardiol [Internet]. 2020;27(3):142-52. Disponible en: https://www.sciencedirect.com/science/article/pii/S0120563320300784 DOI: 10.1016/j.rccar.2020.04.006

Wang H, Li X, Li T, Zhang S, Wang L, Wu X, et al. The genetic sequence, origin, and diagnosis of SARS-CoV-2. Eur J Clin Microbiol Infect Dis [Internet]. 2020;39(9):1629-35. Disponible en: https://doi.org/10.1007/s10096-020-03899-4 DOI: 10.1007/s10096-020-03899-4 PMID 32333222 PMCID PMC7180649

Lang JP, Wang X, Moura FA, Siddiqi HK, Morrow DA, Bohula EA. A current review of COVID-19 for the cardiovascular specialist. Am Heart J [Internet]. 2020;226:29-44. Disponible en: https://www.sciencedirect.com/science/article/pii/S0002870320301332 DOI: 10.1016/j.ahj.2020.04.025 PMID 32497913 PMCID PMC7252118

Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun [Internet]. 2020;109:102433. Disponible en: http://www.sciencedirect.com/science/article/pii/S0896841120300469 DOI: 10.1016/j.jaut.2020.102433 PMID 32113704 PMCID PMC7127067

Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis [Internet]. 2020;94:91-5. Disponible en: https://www.ijidonline.com/article/S1201-9712(20)30136-3/fulltext DOI: 10.1016/j.ijid.2020.03.017 PMID 32173574 PMCID PMC7194638

Guo J, Huang Z, Lin L, Lv J. Coronavirus Disease 2019 (COVID‐19) and Cardiovascular Disease: A Viewpoint on the Potential Influence of Angiotensin‐Converting Enzyme Inhibitors/Angiotensin Receptor Blockers on Onset and Severity of Severe Acute Respiratory Syndrome Coronavirus 2 Infection. J Am Heart Assoc [Internet]. 2020;9(7):e016219. Disponible en: https://doi.org/10.1161/JAHA.120.016219 DOI: 10.1161/JAHA.120.016219 PMID 32233755 PMCID PMC7428639

Salazar M, Barochiner J, Espeche W, Ennis I. COVID-19, hipertensión y enfermedad cardiovascular. Hipertens y Riesgo Vasc [Internet]. 2020;37(4):176-80. Disponible en: https://www.sciencedirect.com/science/article/pii/S1889183720300659 DOI: 10.1016/j.hipert.2020.06.003 PMID 32591283 PMCID PMC7301092

Inciardi RM, Adamo M, Lupi L, Cani DS, Di Pasquale M, Tomasoni D, et al. Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy. Eur Heart J [Internet]. 2020;41(19):1821-9. Disponible en: https://doi.org/10.1093/eurheartj/ehaa388 DOI: 10.1093/eurheartj/ehaa388 PMID 32383763 PMCID PMC7239204

Fernández-Pérez GC, Oñate Miranda M, Fernández-Rodríguez P, Velasco Casares M, Corral de la Calle M, Franco López Á, et al. SARS-CoV-2: cómo es, cómo actúa y cómo se expresa en la imagen. Radiologia [Internet]. 2021;63(2):115-26. Disponible en: https://www.elsevier.es/es-revista-radiologia-119-articulo-sars-cov-2-como-es-como-actua-S0033833820301582 DOI: 10.1016/j.rx.2020.10.006 PMID 33309398 PMCID PMC7671642

Choi M, Aiello EA, Ennis IL, Villa-Abrille MC. El SRAA y el SARS-CoV-2: el acertijo a resolver. Hipertens y Riesgo Vasc [Internet]. 2020;37(4):169-75. Disponible en: https://www.sciencedirect.com/science/article/pii/S1889183720300568 DOI: 10.1016/j.hipert.2020.05.005 PMID 32527699 PMCID PMC7250776

Lamas-Barreiro JM, Alonso-Suárez M, Fernández-Martín JJ, Saavedra-Alonso JA. Supresión de angiotensina II en la infección por el virus SARS-CoV-2: una propuesta terapéutica. Nefrología [Internet]. 2020;40(3):213-6. Disponible en: https://www.revistanefrologia.com/es-linkresolver-supresion-angiotensina-ii-infeccion-por-S0211699520300448 DOI 10.1016/j.nefro.2020.04.006 PMID 32456945 PMCID PMC7190491

Ivermectin in Adults With Severe COVID-19. - Full Text View - ClinicalTrials.gov [Internet]. 2021. Disponible en: https://clinicaltrials.gov/ct2/show/NCT04602507?term=covid19+eca&draw=2&rank=1

Augustine R, S A, Nayeem A, Salam SA, Augustine P, Dan P, et al. Increased complications of COVID-19 in people with cardiovascular disease: Role of the renin–angiotensin-aldosterone system (RAAS) dysregulation. Chem Biol Interact [Internet]. 2022;351:109738. Disponible en: https://www.sciencedirect.com/science/article/pii/S0009279721003768 DOI: 10.1016/j.cbi.2021.109738 PMID 34740598 PMCID PMC8563522

Kai H, Kai M. Interactions of coronaviruses with ACE2, angiotensin II, and RAS inhibitors - lessons from available evidence and insights into COVID-19. Hypertens Res [Internet]. 2020;43(7):648-54. Disponible en: https://doi.org/10.1038/s41440-020-0455-8 DOI: 10.1038/s41440-020-0455-8 PMID 32341442 PMCID PMC7184165

Zheng Y-Y, Ma Y-T, Zhang J-Y, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol [Internet]. 2020;17(5):259-60. Disponible en: https://doi.org/10.1038/s41569-020-0360-5 DOI: 10.1038/s41569-020-0360-5 PMID 32139904 PMCID PMC7095524

Nishiga M, Wang DW, Han Y, Lewis DB, Wu JC. COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives. Nat Rev Cardiol [Internet]. 2020;17(9):543-58. Disponible en: https://doi.org/10.1038/s41569-020-0413-9 DOI: 10.1038/s41569-020-0413-9 PMID 32690910 PMCID PMC7370876

Semenzato L, Botton J, Drouin J, Baricault B, Vabre C, Cuenot F, et al. Antihypertensive Drugs and COVID-19 Risk. Hypertension [Internet]. 2021;77(3):833-42. Disponible en: https://doi.org/10.1161/HYPERTENSIONAHA.120.16314 DOI: 10.1161/HYPERTENSIONAHA.120.16314 PMID 33423528 PMCID PMC7884243

Copur S, Kanbay A, Kanbay M. Should we continue to use renin–angiotensin–aldosterone system blockers in patients with COVID-19? Clin Kidney J [Internet]. 2022;15(5):852-4. Disponible en: https://doi.org/10.1093/ckj/sfac001 DOI: 10.1093/ckj/sfac001 PMID 35498886 PMCID PMC8755383

Sriram K, Insel PA. Risks of ACE Inhibitor and ARB Usage in COVID-19: Evaluating the Evidence. Clin Pharmacol Ther [Internet]. 2020;108(2):236-41. Disponible en: https://doi.org/10.1002/cpt.1863 DOI: 10.1002/cpt.1863 PMID 32320478 PMCID PMC7264499

Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med [Internet]. 2020;8(4):e21. Disponible en: https://doi.org/10.1016/S2213-2600(20)30116-8 DOI: 10.1016/S2213-2600(20)30116-8 PMID 32171062 PMCID PMC7118626

Pal A, Ahirwar AK, Sakarde A, Asia P, Gopal N, Alam S, et al. COVID-19 and cardiovascular disease: a review of current knowledge. Horm Mol Biol Clin Invest. 2021;42(1):99-104. Disponible en: https://doi.org/10.1515/hmbci-2020-0052 DOI: 10.1515/hmbci-2020-0052 PMID 33544511

Mourad J-J, Levy BI. Interaction between RAAS inhibitors and ACE2 in the context of COVID-19. Nat Rev Cardiol [Internet]. 2020;17(5):313. Disponible en: https://doi.org/10.1038/s41569-020-0368-x DOI: 10.1038/s41569-020-0368-x PMID 32231328 PMCID PMC7104419

Imperial College London. Preventing Cardiac Complication of COVID-19 Disease With Early Acute Coronary Syndrome Therapy: A Randomised Controlled Trial. (C-19-ACS). ClinicalTrials.gov. 2020. Disponible en: https://beta.clinicaltrials.gov/study/NCT04333407

Luo J, Zhu X, Jian J, Chen X, Yin K. Cardiovascular disease in patients with COVID-19: evidence from cardiovascular pathology to treatment. Acta Biochim Biophys Sin (Shanghai) [Internet]. 2021;53(3):273-82. Disponible en: http://www.sciengine.com/doi/10.1093/abbs/gmaa176 DOI: 10.1093/abbs/gmaa176 PMID 33428706 PMCID PMC7929476

Goire Guevara G. Repercusión en la salud cardiovascular del COVID-19. Rev Cuba Cardiol y Cirugía Cardiovasc [Internet]. 2020;26(2). Disponible en: https://revcardiologia.sld.cu/index.php/revcardiologia/article/view/972

Tersalvi G, Vicenzi M, Calabretta D, Biasco L, Pedrazzini G, Winterton D. Elevated Troponin in Patients With Coronavirus Disease 2019: Possible Mechanisms. J Card Fail [Internet]. 2020;26(6):470-5. Disponible en: https://doi.org/10.1016/j.cardfail.2020.04.009 DOI: 10.1016/j.cardfail.2020.04.009 PMID 32315733 PMCID PMC7166030

Gupta AK, Jneid H, Addison D, Ardehali H, Boehme AK, Borgaonkar S, et al. Current Perspectives on Coronavirus Disease 2019 and Cardiovascular Disease: A White Paper by the JAHA Editors. J Am Heart Assoc [Internet]. 2020;9(12):e017013. Disponible en: https://doi.org/10.1161/JAHA.120.017013 DOI: 10.1161/JAHA.120.017013 PMID 32347144 PMCID PMC7429024

Irabien-Ortiz Á, Carreras-Mora J, Sionis A, Pàmies J, Montiel J, Tauron M. Miocarditis fulminante por COVID-19. Rev Española Cardiol [Internet]. 2020;73(6):503-4. Disponible en: https://www.revespcardiol.org/es-miocarditis-fulminante-por-covid-19-articulo-S0300893220301743 DOI: 10.1016/j.recesp.2020.04.001 PMID 32292228 PMCID PMC7151531

Siripanthong B, Nazarian S, Muser D, Deo R, Santangeli P, Khanji MY, et al. Recognizing COVID-19-related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management. Hear Rhythm [Internet]. 2020;17(9):1463-71. Disponible en: https://doi.org/10.1016/j.hrthm.2020.05.001 DOI: 10.1016/j.hrthm.2020.05.001 PMID 32387246 PMCID PMC7199677

Cizgici AY, Zencirkiran Agus H, Yildiz M. COVID-19 myopericarditis: It should be kept in mind in today’s conditions. Am J Emerg Med [Internet]. 2020;38(7):1547.e5-1547.e6. Disponible en: https://www.sciencedirect.com/science/article/pii/S0735675720303107 DOI: 10.1016/j.ajem.2020.04.080 PMID 32360119 PMCID PMC7187845

Trogen B, Gonzalez FJ, Shust GF. COVID-19-Associated Myocarditis in an Adolescent. Pediatr Infect Dis J [Internet]. 2020;39(8):e204-5. Disponible en: https://journals.lww.com/pidj/Fulltext/2020/08000/COVID_19_Associated_Myocarditis_in_an_Adolescent.31.aspx. DOI: 10.1097/inf.0000000000002788 PMID 32502128

Kim I-C, Kim JY, Kim HA, Han S. COVID-19-related myocarditis in a 21-year-old female patient. Eur Heart J [Internet]. 2020;41(19):1859. Disponible en: https://doi.org/10.1093/eurheartj/ehaa288 DOI: 10.1093/eurheartj/ehaa288 PMID 32282027 PMCID PMC7184491

Bikdeli B, Madhavan M V, Jimenez D, Chuich T, Dreyfus I, Driggin E, et al. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review. J Am Coll Cardiol [Internet]. 2020;75(23):2950-73. Disponible en: https://www.sciencedirect.com/science/article/pii/S0735109720350087 DOI: 10.1016/j.jacc.2020.04.031 PMID 32311448 PMCID PMC7164881

Wu L, O’Kane AM, Peng H, Bi Y, Motriuk-Smith D, Ren J. SARS-CoV-2 and cardiovascular complications: From molecular mechanisms to pharmaceutical management. Biochem Pharmacol [Internet]. 2020;178:114114. Disponible en: https://www.sciencedirect.com/science/article/pii/S0006295220303506 DOI: 10.1016/j.bcp.2020.114114 PMID 32579957 PMCID PMC7306106

Basso C, Leone O, Rizzo S, De Gaspari M, van der Wal AC, Aubry M-C, et al. Pathological features of COVID-19-associated myocardial injury: a multicentre cardiovascular pathology study. Eur Heart J [Internet]. 2020;41(39):3827-35. Disponible en: https://doi.org/10.1093/eurheartj/ehaa664 DOI: 10.1093/eurheartj/ehaa664 PMID 32968776 PMCID PMC7543528

DeFilippis EM, Reza N, Donald E, Givertz MM, Lindenfeld J, Jessup M. Considerations for Heart Failure Care During the COVID-19 Pandemic. JACC Hear Fail [Internet]. 2020;8(8):681-91. Disponible en: https://www.sciencedirect.com/science/article/pii/S2213177920302730 DOI: 10.1016/j.jchf.2020.05.006 PMID 32493638 PMCID PMC7266777

Mehra MR, Ruschitzka F. COVID-19 Illness and Heart Failure: A Missing Link? JACC Hear Fail [Internet]. 2020;8(6):512-4. Disponible en: https://www.sciencedirect.com/science/article/pii/S2213177920301505 DOI: 10.1016/j.jchf.2020.03.004 PMID 32360242 PMCID PMC7151428

Chen C, Li H, Hang W, Wang DW. Cardiac injuries in coronavirus disease 2019 (COVID-19). J Mol Cell Cardiol [Internet]. 2020;145:25-9. Disponible en: https://doi.org/10.1016/j.yjmcc.2020.06.002 DOI: 10.1016/j.yjmcc.2020.06.002 PMID 32526224 PMCID PMC7831647

Yonas E, Alwi I, Pranata R, Huang I, Lim MA, Gutierrez EJ, et al. Effect of heart failure on the outcome of COVID-19 - A meta analysis and systematic review. Am J Emerg Med [Internet]. 2021;46:204-11. Disponible en: https://www.sciencedirect.com/science/article/pii/S0735675720306021 DOI: 10.1016/j.ajem.2020.07.009 PMID 33071085 PMCID PMC7347316

Vaught M, Jordan DC, Bastian H. Concern noted: a descriptive study of editorial expressions of concern in PubMed and PubMed Central. Res Integr Peer Rev [Internet]. 2017;2(1):10. Disponible en: https://doi.org/10.1186/s41073-017-0030-2 DOI: 10.1186/s41073-017-0030-2 PMID 28758029 PMCID PMC5526611

Manolis AS, Manolis TA, Manolis AA, Papatheou D, Melita H. COVID-19 Infection: Viral Macro- and Micro-Vascular Coagulopathy and Thromboembolism/Prophylactic and Therapeutic Management. J Cardiovasc Pharmacol Ther [Internet]. 2020;26(1):12-24. Disponible en: https://doi.org/10.1177/1074248420958973 DOI: 10.1177/1074248420958973 PMID 32924567 PMCID PMC7492826

Chang W-T, Toh HS, Liao C-T, Yu W-L. Cardiac Involvement of COVID-19: A Comprehensive Review. Am J Med Sci [Internet]. 2021;361(1):14-22. Disponible en: https://doi.org/10.1016/j.amjms.2020.10.002 DOI: 10.1016/j.amjms.2020.10.002 PMID 33187633 PMCID PMC7536131

Amin A, Sadeghipour P, Chitsazan M. Chapter 41 - Cardiovascular Disease in the COVID-19 Era: Myocardial Injury and Thrombosis. En: Maleki M, Alizadehasl A, Hagcccchjoo M, editores. Practical Cardiology Principles and Approaches [Internet]. 2.a ed. Amsterdam-Netherlands: Elsevier; 2022. p. 737-43. Disponible en: https://www.sciencedirect.com/science/article/pii/B9780323809153000442 DOI: 10.1016/B978-0-323-80915-3.00044-2

Pérez Dueñas V, Allona Krauel M, Agrela Rojas E, Ramírez Prieto MT, Díez Izquierdo L, López de la Guardia U, et al. Pulmones azules en pacientes COVID-19: un paso más allá del diagnóstico de tromboembolismo pulmonar mediante TCMD con mapa de yodo. Arch Bronconeumol [Internet]. 2021;57:35-46. Disponible en: https://www.archbronconeumol.org/en-pulmones-azules-pacientes-covid-19-un-articulo-S0300289620302660 DOI: 10.1016/j.arbres.2020.07.031 PMID 34629642 PMCID PMC7455161

Ouldali N, Pouletty M, Mariani P, Beyler C, Blachier A, Bonacorsi S, et al. Emergence of Kawasaki disease related to SARS-CoV-2 infection in an epicentre of the French COVID-19 epidemic: a time-series analysis. Lancet Child Adolesc Heal [Internet]. 2020;4(9):662-8. Disponible en: https://doi.org/10.1016/S2352-4642(20)30175-9 DOI: 10.1016/S2352-4642(20)30175-9 PMID 32622376 PMCID PMC7332278

Pouletty M, Borocco C, Ouldali N, Caseris M, Basmaci R, Lachaume N, et al. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Ann Rheum Dis [Internet]. 2020;79(8):999-1006. Disponible en: http://ard.bmj.com/content/79/8/999.abstract DOI: 10.1136/annrheumdis-2020-217960 PMID 32527868 PMCID PMC7299653

Bhatla A, Mayer MM, Adusumalli S, Hyman MC, Oh E, Tierney A, et al. COVID-19 and cardiac arrhythmias. Hear Rhythm [Internet]. 2020;17(9):1439-44. Disponible en: https://doi.org/10.1016/j.hrthm.2020.06.016 DOI: 10.1016/j.hrthm.2020.06.016 PMID 32585191 PMCID PMC7307518

Mora G. COVID-19 y arritmias: relación y riesgo. Rev Colomb Cardiol [Internet]. 2020;27(3):153-9. Disponible en: https://www.elsevier.es/es-revista-revista-colombiana-cardiologia-203-articulo-covid-19-arritmias-relacion-riesgo-S0120563320300930 DOI: 10.1016/j.rccar.2020.05.004

Wu C-I, Postema PG, Arbelo E, Behr ER, Bezzina CR, Napolitano C, et al. SARS-CoV-2, COVID-19, and inherited arrhythmia syndromes. Hear Rhythm [Internet]. 2020;17(9):1456-62. Disponible en: https://doi.org/10.1016/j.hrthm.2020.03.024 DOI: 10.1016/j.hrthm.2020.03.024 PMID 32244059 PMCID PMC7156157

Barbagelata A, Perna E. Prevención del colapso del sistema de salud en pacientes cardiovasculares con COVID-19 - SIAC [Internet]. 2020. Disponible en: https://www.siacardio.com/novedades/covid-19/prevencion-del-colapso-del-sistema-de-salud-en-pacientes-cardiovasculares-con-covid-19/

de Cortina Camarero C, Gómez Mariscal E, Espejo Bares V, Núñez Garcia A, Muñoz Aguilera R, Botas Rodriguez J. SARS-CoV-2 infection: A predisposing factor for acute coronary syndrome. Med Clínica [Internet]. 2021;157(3):114-7. Disponible en: https://www.sciencedirect.com/science/article/pii/S2387020621003442 DOI: 10.1016/j.medcle.2021.01.012 PMID 34250244 PMCID PMC8258610

Metzler B, Siostrzonek P, Binder RK, Bauer A, Reinstadler SJ. Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage. Eur Heart J [Internet]. 2020;41(19):1852-3. Disponible en: https://doi.org/10.1093/eurheartj/ehaa314 DOI: 10.1093/eurheartj/ehaa314 PMID 32297932 PMCID PMC7184486

Braiteh N, Rehman W ur, Alom M, Skovira V, Breiteh N, Rehman I, et al. Decrease in acute coronary syndrome presentations during the COVID-19 pandemic in upstate New York. Am Heart J [Internet]. 2020;226:147-51. Disponible en: https://www.sciencedirect.com/science/article/pii/S0002870320301460 DOI: 10.1016/j.ahj.2020.05.009 PMID 32569892 PMCID PMC7244433

Mafham MM, Spata E, Goldacre R, Gair D, Curnow P, Bray M, et al. COVID-19 pandemic and admission rates for and management of acute coronary syndromes in England. Lancet [Internet]. 2020;396(10248):381-9. Disponible en: https://doi.org/10.1016/S0140-6736(20)31356-8 DOI: 10.1016/S0140-6736(20)31356-8 PMID 32679111 PMCID PMC7429983

Rifaie O, Reda A, Hatata A, Gamal A, Abdelmonaem M. Short-term impact of COVID-19 infection on right ventricular functions: single center observational study. Egypt Hear J [Internet]. 2022;74(1):7. Disponible en: https://doi.org/10.1186/s43044-022-00242-4 DOI: 10.1186/s43044-022-00242-4 PMID 35107643 PMCID PMC8809060

Golaszewski NM, LaCroix AZ, Godino JG, Allison MA, Manson JE, King JJ, et al. Evaluation of Social Isolation, Loneliness, and Cardiovascular Disease Among Older Women in the US. JAMA Netw Open [Internet]. 2022;5(2):e2146461-e2146461. Disponible en: https://doi.org/10.1001/jamanetworkopen.2021.46461 DOI: 10.1001/jamanetworkopen.2021.46461 PMID 35107574 PMCID PMC8811637