Advanced Imaging Supports the Mechanistic Role of Autoimmunity and Plaque Rupture in COVID-19 Heart Involvement.

IF 8.4 2区 医学 Q1 ALLERGY Clinical Reviews in Allergy & Immunology Pub Date : 2023-02-01 DOI:10.1007/s12016-022-08925-1
Maria Elena Laino, Angela Ammirabile, Francesca Motta, Maria De Santis, Victor Savevski, Marco Francone, Arturo Chiti, Lorenzo Mannelli, Carlo Selmi, Lorenzo Monti
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引用次数: 2

Abstract

The cardiovascular system is frequently affected by coronavirus disease-19 (COVID-19), particularly in hospitalized cases, and these manifestations are associated with a worse prognosis. Most commonly, heart involvement is represented by myocarditis, myocardial infarction, and pulmonary embolism, while arrhythmias, heart valve damage, and pericarditis are less frequent. While the clinical suspicion is necessary for a prompt disease recognition, imaging allows the early detection of cardiovascular complications in patients with COVID-19. The combination of cardiothoracic approaches has been proposed for advanced imaging techniques, i.e., CT scan and MRI, for a simultaneous evaluation of cardiovascular structures, pulmonary arteries, and lung parenchyma. Several mechanisms have been proposed to explain the cardiovascular injury, and among these, it is established that the host immune system is responsible for the aberrant response characterizing severe COVID-19 and inducing organ-specific injury. We illustrate novel evidence to support the hypothesis that molecular mimicry may be the immunological mechanism for myocarditis in COVID-19. The present article provides a comprehensive review of the available evidence of the immune mechanisms of the COVID-19 cardiovascular injury and the imaging tools to be used in the diagnostic workup. As some of these techniques cannot be implemented for general screening of all cases, we critically discuss the need to maximize the sustainability and the specificity of the proposed tests while illustrating the findings of some paradigmatic cases.

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先进成像支持自身免疫和斑块破裂在COVID-19心脏受累中的机制作用。
心血管系统经常受到冠状病毒病-19 (COVID-19)的影响,特别是在住院病例中,这些表现与较差的预后相关。最常见的心脏受累表现为心肌炎、心肌梗死和肺栓塞,而心律失常、心瓣膜损伤和心包炎则较少见。虽然临床怀疑对于迅速识别疾病是必要的,但成像可以早期发现COVID-19患者的心血管并发症。已经提出了采用先进的成像技术,即CT扫描和MRI,同时评估心血管结构,肺动脉和肺实质的心胸联合入路。已经提出了几种机制来解释心血管损伤,其中确定宿主免疫系统负责表征严重COVID-19的异常反应并诱导器官特异性损伤。我们提供了新的证据来支持分子模仿可能是COVID-19心肌炎的免疫机制的假设。本文全面综述了COVID-19心血管损伤的免疫机制的现有证据以及用于诊断检查的成像工具。由于其中一些技术不能用于所有病例的一般筛查,我们批判性地讨论了最大限度地提高所提议测试的可持续性和特异性的必要性,同时说明了一些范例案例的发现。
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来源期刊
CiteScore
22.30
自引率
1.10%
发文量
58
审稿时长
6-12 weeks
期刊介绍: Clinical Reviews in Allergy & Immunology is a scholarly journal that focuses on the advancement of clinical management in allergic and immunologic diseases. The journal publishes both scholarly reviews and experimental papers that address the current state of managing these diseases, placing new data into perspective. Each issue of the journal is dedicated to a specific theme of critical importance to allergists and immunologists, aiming to provide a comprehensive understanding of the subject matter for a wide readership. The journal is particularly helpful in explaining how novel data impacts clinical management, along with advancements such as standardized protocols for allergy skin testing and challenge procedures, as well as improved understanding of cell biology. Ultimately, the journal aims to contribute to the improvement of care and management for patients with immune-mediated diseases.
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