Inflammatory damage to the myocardium in patients with novel coronavirus disease (COVID-19)

Authors

DOI:

https://doi.org/10.14739/2310-1210.2021.4.211033

Keywords:

COVID-19, myocarditis, pathology, clinical manifestation, treatment

Abstract

The aim. To analyze current evidence about etiology, pathogenesis, clinical manifestation, diagnosis, and treatment of patients with COVID-19 associated myocarditis.

Multisystem inflammatory syndrome is possible in COVID-19 including inflammatory damage to the myocardium, which may last over several months and worsen the disease outcome. Mechanisms of inflammatory cardiac damage include direct damage by SARS-CoV-2, massive release of cytokines, dysregulation of the renin-angiotensin system. All these factors can aggravate pre-existing overload of the right heart chambers in patients with multifocal pneumonia, thrombosis of coronary arteries and myocardial ischemia. Inflammation of the myocardium manifests with typical symptoms of myocarditis and pericarditis. It can be accompanied by heart failure with rapid decompensation, arrhythmia, acute coronary syndrome or even sudden death. Laboratory findings in COVID-19 associated myocarditis include high levels of CRP, BNP, NT-proBNP, and D-dimer. Transthoracic echocardiography allows for an assessment of the left ventricular dysfunction and diagnosis of a pericardial effusion. Heart MRI according to the Lake Louise Diagnostic Criteria is the most sensitive diagnostic method in acute myocarditis. Medical imaging is indicated only in cases when results obtained can potentially influence the patient management tactics and should be performed according to the shortest protocol due to high risks of virus transmission.

Conclusions. ESC experts (2020) do not provide unanimous recommendations for the treatment of SARS-CoV-2 associated myocarditis, considering a lack of the evidence base. Patient management is limited to adequate treatment of heart failure, arrhythmia, acute coronary syndrome, and prevention of thrombotic complications. Ongoing studies are aiming to evaluate potential place of glucocorticoids, intravenous immunoglobulins, antibodies against IL-6 receptor, colchicine in the treatment of COVID-19.

Author Biographies

V. V. Buheruk, Odesa National Medical University, Ukraine

MD, PhD, Associate Professor of the Department of General Practice

O. B. Voloshyna, Odesa National Medical University, Ukraine

MD, PhD, DSc, Professor, Head of the Department of General Practice

І. V. Balashova, Odesa National Medical University, Ukraine

MD, PhD, Senior Researcher, Assistant of the Department of General Practice

References

European Society of Cardiology. (2020). ESC Guidance for the Diagnosis and Management of CV Disease during the COVID-19 Pandemic. https://www.escardio.org/Education/COVID-19-and-Cardiology/ESC-COVID-19-Guidance

Bhimraj, A., Morgan, R. L., Shumaker, A. H., Lavergne, V., Baden, L., Cheng, V. C., Edwards, K. M., Gandhi, R., Muller, W. J., O'Horo, J. C., Shoham, S., Murad, M. H., Mustafa, R. A., Sultan, S., & Falck-Ytter, Y. (2020). Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19. Clinical Infectious Diseases, Article ciaa478. https://doi.org/10.1093/cid/ciaa478

Guo, T., Fan, Y., Chen, M., Wu, X., Zhang, L., He, T., Wang, H., Wan, J., Wang, X., & Lu, Z. (2020). Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiology, 5(7), 811-818. https://doi.org/10.1001/jamacardio.2020.1017

Royal College of Paediatrics and Child Health. (2020, April 27). PICS Statement regarding novel presentation of multi-system inflammatory disease. Paediatric Critical Care Society. https://pccsociety.uk/news/pics-statement-regarding-novel-presentation-of-multi-system-inflammatory-disease/

Carfì, A., Bernabei, R., Landi, F., & Gemelli Against COVID-19 Post-Acute Care Study Group. (2020). Persistent Symptoms in Patients After Acute COVID-19. JAMA, 324(6), 603-605. https://doi.org/10.1001/jama.2020.12603

Puntmann, V. O., Carerj, M. L., Wieters, I., Fahim, M., Arendt, C., Hoffmann, J., Shchendrygina, A., Escher, F., Vasa-Nicotera, M., Zeiher, A. M., Vehreschild, M., & Nagel, E. (2020). Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiology, 5(11), 1265-1273. https://doi.org/10.1001/jamacardio.2020.3557

Zheng, Y. Y., Ma, Y. T., Zhang, J. Y., & Xie, X. (2020). COVID-19 and the cardiovascular system. Nature Reviews Cardiology, 17(5), 259-260. https://doi.org/10.1038/s41569-020-0360-5

Imazio, M., Klingel, K., Kindermann, I., Brucato, A., De Rosa, F. G., Adler, Y., & De Ferrari, G. M. (2020). COVID-19 pandemic and troponin: indirect myocardial injury, myocardial inflammation or myocarditis? Heart, 106(15), 1127-1131. https://doi.org/10.1136/heartjnl-2020-317186

Liu, Y., Yang, Y., Zhang, C., Huang, F., Wang, F., Yuan, J., Wang, Z., Li, J., Li, J., Feng, C., Zhang, Z., Wang, L., Peng, L., Chen, L., Qin, Y., Zhao, D., Tan, S., Yin, L., Xu, J., Zhou, C., … Liu, L. (2020). Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Science China Life Sciences, 63(3), 364-374. https://doi.org/10.1007/s11427-020-1643-8

Babapoor-Farrokhran, S., Gill, D., Walker, J., Rasekhi, R. T., Bozorgnia, B., & Amanullah, A. (2020). Myocardial injury and COVID-19: Possible mechanisms. Life Sciences, 253, Article 117723. https://doi.org/10.1016/j.lfs.2020.117723

Tavazzi, G., Pellegrini, C., Maurelli, M., Belliato, M., Sciutti, F., Bottazzi, A., Sepe, P. A., Resasco, T., Camporotondo, R., Bruno, R., Baldanti, F., Paolucci, S., Pelenghi, S., Iotti, G. A., Mojoli, F., & Arbustini, E. (2020). Myocardial localization of coronavirus in COVID-19 cardiogenic shock. European Journal of Heart Failure, 22(5), 911-915. https://doi.org/10.1002/ejhf.1828

Xu, Z., Shi, L., Wang, Y., Zhang, J., Huang, L., Zhang, C., Liu, S., Zhao, P., Liu, H., Zhu, L., Tai, Y., Bai, C., Gao, T., Song, J., Xia, P., Dong, J., Zhao, J., & Wang, F. S. (2020). Pathological findings of COVID-19 associated with acute respiratory distress syndrome. The Lancet Respirratory Medicine, 8(4), 420-422. https://doi.org/10.1016/S2213-2600(20)30076-X

Chen, L., Li, X., Chen, M., Feng, Y., & Xiong, C. (2020). The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV-2. Cardiovascular Research, 116(6), 1097-1100. https://doi.org/10.1093/cvr/cvaa078

Chen, C., Zhou, Y., & Wang, D. W. (2020). SARS-CoV-2: a potential novel etiology of fulminant myocarditis. Herz, 45(3), 230-232. https://doi.org/10.1007/s00059-020-04909-z

Santos, R., Sampaio, W. O., Alzamora, A. C., Motta-Santos, D., Alenina, N., Bader, M., & Campagnole-Santos, M. J. (2018). The ACE2/Angiotensin-(1-7)/MAS Axis of the Renin-Angiotensin System: Focus on Angiotensin-(1-7). Physiological Reviews, 98(1), 505-553. https://doi.org/10.1152/physrev.00023.2016

Li, W., Moore, M. J., Vasilieva, N., Sui, J., Wong, S. K., Berne, M. A., Somasundaran, M., Sullivan, J. L., Luzuriaga, K., Greenough, T. C., Choe, H., & Farzan, M. (2003). Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature, 426(6965), 450-454. https://doi.org/10.1038/nature02145

Hoffmann, M., Kleine-Weber, H., Schroeder, S., Kruger, N., Herrler, T., Erichsen, S., Schiergens, T. S., Herrler, G., Wu, N. H., Nitsche, A., Muller, M. A., Drosten, C., & Pohlmann, S. (2020). SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell, 181(2), 271-280.e8. https://doi.org/10.1016/j.cell.2020.02.052

Matheson, N. J., & Lehner, P. J. (2020). How does SARS-CoV-2 cause COVID-19? Science, 369(6503), 510-511. https://doi.org/10.1126/science.abc6156

Liu, P. P., Blet, A., Smyth, D., & Li, H. (2020). The Science Underlying COVID-19: Implications for the Cardiovascular System. Circulation, 142(1), 68-78. https://doi.org/10.1161/CIRCULATIONAHA.120.047549

Li, Z., Guo, X., Hao, W., Wu, Y., Ji, Y., Zhao, Y., Liu, F., & Xie, X. (2003). The relationship between serum interleukins and T-lymphocyte subsets in patients with severe acute respiratory syndrome. Chinese Medical Journal, 116(7), 981-984. https://europepmc.org/article/med/12890366

Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Zhang, L., Fan, G., Xu, J., Gu, X., Cheng, Z., Yu, T., Xia, J., Wei, Y., Wu, W., Xie, X., Yin, W., Li, H., Liu, M., & Xiao, Y. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, 395(10223), 497-506. https://doi.org/10.1016/s0140-6736(20)30183-5

Ruan, Q., Yang, K., Wang, W., Jiang, L., & Song, J. (2020). Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Medicine, 46(5), 846-848. https://doi.org/10.1007/s00134-020-05991-x

Clerkin, K. J., Fried, J. A., Raikhelkar, J., Sayer, G., Griffin, J. M., Masoumi, A., Jain, S. S., Burkhoff, D., Kumaraiah, D., Rabbani, L., Schwartz, A., & Uriel, N. (2020). COVID-19 and Cardiovascular Disease. Circulation, 141(20), 1648-1655. https://doi.org/10.1161/CIRCULATIONAHA.120.046941

Inciardi, R. M., Lupi, L., Zaccone, G., Italia, L., Raffo, M., Tomasoni, D., Cani, D. S., Cerini, M., Farina, D., Gavazzi, E., Maroldi, R., Adamo, M., Ammirati, E., Sinagra, G., Lombardi, C. M., & Metra, M. (2020). Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19). JAMA Cardiology, 5(7), 819-824. https://doi.org/10.1001/jamacardio.2020.1096

Kesici, S., Aykan, H. H., Orhan, D., & Bayrakci, B. (2020). Fulminant COVID-19-related myocarditis in an infant. European Heart Journal, 41(31), 3021. https://doi.org/10.1093/eurheartj/ehaa515

Hu, H., Ma, F., Wei, X., & Fang, Y. (2021). Coronavirus fulminant myocarditis treated with glucocorticoid and human immunoglobulin. European Heart Journal, 42(2), 206. https://doi.org/10.1093/eurheartj/ehaa190

Purohit, R., Kanwal, A., Pandit, A., Patel, B. M., Meininger, G. R., Brown, J. J., Kaliyadan, A. G., & Saini, A. (2020). Acute Myopericarditis with Pericardial Effusion and Cardiac Tamponade in a Patient with COVID-19. American Journal of Case Reports, 21, Article e925554. https://doi.org/10.12659/AJCR.925554

Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., Xiang, J., Wang, Y., Song, B., Gu, X., Guan, L., Wei, Y., Li, H., Wu, X., Xu, J., Tu, S., Zhang, Y., Chen, H., & Cao, B. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet, 395(10229), 1054-1062. https://doi.org/10.1016/S0140-6736(20)30566-3

Wang, D., Hu, B., Hu, C., Zhu, F., Liu, X., Zhang, J., Wang, B., Xiang, H., Cheng, Z., Xiong, Y., Zhao, Y., Li, Y., Wang, X., & Peng, Z. (2020). Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA, 323(11), 1061-1069. https://doi.org/10.1001/jama.2020.1585

Onder, G., Rezza, G., & Brusaferro, S. (2020). Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. JAMA, 323(18), 1775-1776. https://doi.org/10.1001/jama.2020.4683

Boriani, G., Fauchier, L., Aguinaga, L., Beattie, J. M., Blomstrom Lundqvist, C., Cohen, A., Dan, G. A., Genovesi, S., Israel, C., Joung, B., Kalarus, Z., Lampert, R., Malavasi, V. L., Mansourati, J., Mont, L., Potpara, T., Thornton, A., Lip, G., & ESC Scientific Document Group. (2019). European Heart Rhythm Association (EHRA) consensus document on management of arrhythmias and cardiac electronic devices in the critically ill and post-surgery patient, endorsed by Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Cardiac Arrhythmia Society of Southern Africa (CASSA), and Latin American Heart Rhythm Society (LAHRS). EP Europace, 21(1), 7-8. https://doi.org/10.1093/europace/euy110

Madjid, M., Vela, D., Khalili-Tabrizi, H., Casscells, S. W., & Litovsky, S. (2007). Systemic Infections Cause Exaggerated Local Inflammation in Atherosclerotic Coronary Arteries: Clues to the Triggering Effect of Acute Infections on Acute Coronary Syndromes. Texas Heart Institute journal, 34(1), 11-18.

Arentz, M., Yim, E., Klaff, L., Lokhandwala, S., Riedo, F. X., Chong, M., & Lee, M. (2020). Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State. JAMA, 323(16), 1612-1614. https://doi.org/10.1001/jama.2020.4326

Shi, S., Qin, M., Shen, B., Cai, Y., Liu, T., Yang, F., Gong, W., Liu, X., Liang, J., Zhao, Q., Huang, H., Yang, B., & Huang, C. (2020). Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiology, 5(7), 802-810. https://doi.org/10.1001/jamacardio.2020.0950

Qin, J. J., Cheng, X., Zhou, F., Lei, F., Akolkar, G., Cai, J., Zhang, X. J., Blet, A., Xie, J., Zhang, P., Liu, Y. M., Huang, Z., Zhao, L. P., Lin, L., Xia, M., Chen, M. M., Song, X., Bai, L., Chen, Z., Zhang, X., … Li, H. (2020). Redefining Cardiac Biomarkers in Predicting Mortality of Inpatients With COVID-19. Hypertension, 76(4), 1104-1112. https://doi.org/10.1161/HYPERTENSIONAHA.120.15528

Mueller, C., McDonald, K., de Boer, R. A., Maisel, A., Cleland, J., Kozhuharov, N., Coats, A., Metra, M., Mebazaa, A., Ruschitzka, F., Lainscak, M., Filippatos, G., Seferovic, P. M., Meijers, W. C., Bayes-Genis, A., Mueller, T., Richards, M., Januzzi, J. L., Jr., & Heart Failure Association of the European Society of Cardiology. (2019). Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations. European Journal of Heart Failure, 21(6), 715-731. https://doi.org/10.1002/ejhf.1494

Giannitsis, E., Mair, J., Christersson, C., Siegbahn, A., Huber, K., Jaffe, A. S., Peacock, W. F., Plebani, M., Thygesen, K., Möckel, M., Mueller, C., Lindahl, B., & Biomarker Study Group of the European Society of Cardiology (ESC) Acute Cardiovascular Care Association (ACCA). (2017). How to use D-dimer in acute cardiovascular care. European Heart Journal. Acute Cardiovascular Care, 6(1), 69-80. https://doi.org/10.1177/2048872615610870

Yang, W., Cao, Q., Qin, L., Wang, X., Cheng, Z., Pan, A., Dai, J., Sun, Q., Zhao, F., Qu, J., & Yan, F. (2020). Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19):A multi-center study in Wenzhou city, Zhejiang, China. Journal of Infection, 80(4), 388-393. https://doi.org/10.1016/j.jinf.2020.02.016

Angeli, F., Spanevello, A., De Ponti, R., Visca, D., Marazzato, J., Palmiotto, G., Feci, D., Reboldi, G., Fabbri, L. M., & Verdecchia, P. (2020). Electrocardiographic features of patients with COVID-19 pneumonia. European Journal of Internal Medicine, 78, 101-106. https://doi.org/10.1016/j.ejim.2020.06.015

Čelutkienė, J., Lainscak, M., Anderson, L., Gayat, E., Grapsa, J., Harjola, V. P., Manka, R., Nihoyannopoulos, P., Filardi, P. P., Vrettou, R., Anker, S. D., Filippatos, G., Mebazaa, A., Metra, M., Piepoli, M., Ruschitzka, F., Zamorano, J. L., Rosano, G., & Seferovic, P. (2020). Imaging in patients with suspected acute heart failure: timeline approach position statement on behalf of the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure, 22(2), 181-195. https://doi.org/10.1002/ejhf.1678

Ferreira, V. M., Schulz-Menger, J., Holmvang, G., Kramer, C. M., Carbone, I., Sechtem, U., Kindermann, I., Gutberlet, M., Cooper, L. T., Liu, P., & Friedrich, M. G. (2018). Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations. Journal of the American College of Cardiology, 72(24), 3158-3176. https://doi.org/10.1016/j.jacc.2018.09.072

Driggin, E., Madhavan, M. V., Bikdeli, B., Chuich, T., Laracy, J., Biondi-Zoccai, G., Brown, T. S., Der Nigoghossian, C., Zidar, D. A., Haythe, J., Brodie, D., Beckman, J. A., Kirtane, A. J., Stone, G. W., Krumholz, H. M., & Parikh, S. A. (2020). Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic. Journal of the American College of Cardiology, 75(18), 2352-2371. https://doi.org/10.1016/j.jacc.2020.03.031

Bucciarelli-Ducci, C., Bryant, J., Carr, J., Dyke, C., Elliott, M., Lawton, C. B., Ordovas, K., Plein, S., Powell, A., Raman, S., Technologist Section, & Clinical Practice Committee. (2020, March 25). SCMR’S COVID-19 Preparedness Toolkit. Society for Cardiovascular Magnetic Resonance. https://scmr.org/page/COVID19

Fischer, Q., Brillat-Savarin, N., Ducrocq, G., & Ou, P. (2020). Case report of an isolated myocarditis due to COVID-19 infection in a paediatric patient. European Heart Journal. Case Reports, 4(FI1), 1-5. https://doi.org/10.1093/ehjcr/ytaa180

Mahmud, E., Dauerman, H. L., Welt, F., Messenger, J. C., Rao, S. V., Grines, C., Mattu, A., Kirtane, A. J., Jauhar, R., Meraj, P., Rokos, I. C., Rumsfeld, J. S., & Henry, T. D. (2020). Management of Acute Myocardial Infarction During the COVID-19 Pandemic: A Position Statement From the Society for Cardiovascular Angiography and Interventions (SCAI), the American College of Cardiology (ACC), and the American College of Emergency Physicians (ACEP). Journal of the American College of Cardiology, 76(11), 1375-1384. https://doi.org/10.1016/j.jacc.2020.04.039

Halliday, B. P., Wassall, R., Lota, A. S., Khalique, Z., Gregson, J., Newsome, S., Jackson, R., Rahneva, T., Wage, R., Smith, G., Venneri, L., Tayal, U., Auger, D., Midwinter, W., Whiffin, N., Rajani, R., Dungu, J. N., Pantazis, A., Cook, S. A., & Ware, J. S. (2019). Withdrawal of pharmacological treatment for heart failure in patients with recovered dilated cardiomyopathy (TRED-HF): an open-label, pilot, randomised trial. The Lancet, 393(10166), 61-73. https://doi.org/10.1016/s0140-6736(18)32484-x

Seferovic, P. M., Ponikowski, P., Anker, S. D., Bauersachs, J., Chioncel, O., Cleland, J., de Boer, R. A., Drexel, H., Ben Gal, T., Hill, L., Jaarsma, T., Jankowska, E. A., Anker, M. S., Lainscak, M., Lewis, B. S., McDonagh, T., Metra, M., Milicic, D., Mullens, W., Piepoli, M. F., … Coats, A. (2019). Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure, 21(10), 1169-1186. https://doi.org/10.1002/ejhf.1531

Lund, L. C., Reilev, M., Hallas, J., Kristensen, K. B., Thomsen, R. W., Christiansen, C. F., Sørensen, H. T., Johansen, N. B., Brun, N. C., Voldstedlund, M., Støvring, H., Thomsen, M. K., Christensen, S., & Pottegård, A. (2020). Association of Nonsteroidal Anti-inflammatory Drug Use and Adverse Outcomes Among Patients Hospitalized With Influenza. JAMA Network Open, 3(7), Article e2013880. https://doi.org/10.1001/jamanetworkopen.2020.13880

Li, A., Garcia-Bengochea, Y., Stechel, R., & Azari, B. M. (2020). Management of COVID-19 myopericarditis with reversal of cardiac dysfunction after blunting of cytokine storm: a case report. European Heart Journal. Case Reports, 4(FI1), 1-6. https://doi.org/10.1093/ehjcr/ytaa224

(2020, June 16). Low-cost dexamethasone reduces death by up to one third in hospitalised patients with severe respiratory complications of COVID-19. Oxford University. https://www.ox.ac.uk/news/2020-06-16-low-cost-dexamethasone-reduces-death-one-third-hospitalised-patients-severe

Keller, M. J., Kitsis, E. A., Arora, S., Chen, J. T., Agarwal, S., Ross, M. J., Tomer, Y., & Southern, W. (2020). Effect of Systemic Glucocorticoids on Mortality or Mechanical Ventilation in Patients With COVID-19. Journal of Hospital Medicine, 15(8), 489-493. https://doi.org/10.12788/jhm.3497

Deftereos, S. G., Giannopoulos, G., Vrachatis, D. A., Siasos, G. D., Giotaki, S. G., Gargalianos, P., Metallidis, S., Sianos, G., Baltagiannis, S., Panagopoulos, P., Dolianitis, K., Randou, E., Syrigos, K., Kotanidou, A., Koulouris, N. G., Milionis, H., Sipsas, N., Gogos, C., Tsoukalas, G., Olympios, C. D., … GRECCO-19 investigators. (2020). Effect of Colchicine vs Standard Care on Cardiac and Inflammatory Biomarkers and Clinical Outcomes in Patients Hospitalized With Coronavirus Disease 2019: The GRECCO-19 Randomized Clinical Trial. JAMA Network Open, 3(6), Article e2013136. https://doi.org/10.1001/jamanetworkopen.2020.13136

Corrales-Medina, V. F., Alvarez, K. N., Weissfeld, L. A., Angus, D. C., Chirinos, J. A., Chang, C. C., Newman, A., Loehr, L., Folsom, A. R., Elkind, M. S., Lyles, M. F., Kronmal, R. A., & Yende, S. (2015). Association Between Hospitalization for Pneumonia and Subsequent Risk of Cardiovascular Disease. JAMA, 313(3), 264-274. https://doi.org/10.1001/jama.2014.18229

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2021-07-01

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Buheruk VV, Voloshyna OB, Balashova ІV. Inflammatory damage to the myocardium in patients with novel coronavirus disease (COVID-19). Zaporozhye medical journal [Internet]. 2021Jul.1 [cited 2024Apr.23];23(4):555-6. Available from: http://zmj.zsmu.edu.ua/article/view/211033

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Vol. 23 No. 4 (2021)

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Review

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