Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

Myocardial Oedema as a Consequence of Viral Infection and Persistence – a Narrative Review with Focus on COVID-19 and Post COVID Sequelae

Noel G. Panagiotides
,
Michael Poledniczek
ORCID logo ,
Martin Andreas
,
Martin Hülsmann
,
Alfred A. Kocher
,
Christoph W. Kopp
,
Aleksandra Piechota-Polanczyk
,
Annika Weidenhammer
,
Noemi Pavo
,
Patricia P. Wadowski
* ORCID logo
Version 1 : Received: 20 December 2023 / Approved: 20 December 2023 / Online: 20 December 2023 (10:17:33 CET)

A peer-reviewed article of this Preprint also exists.

Panagiotides, N.G.; Poledniczek, M.; Andreas, M.; Hülsmann, M.; Kocher, A.A.; Kopp, C.W.; Piechota-Polanczyk, A.; Weidenhammer, A.; Pavo, N.; Wadowski, P.P. Myocardial Oedema as a Consequence of Viral Infection and Persistence—A Narrative Review with Focus on COVID-19 and Post COVID Sequelae. Viruses 2024, 16, 121. Panagiotides, N.G.; Poledniczek, M.; Andreas, M.; Hülsmann, M.; Kocher, A.A.; Kopp, C.W.; Piechota-Polanczyk, A.; Weidenhammer, A.; Pavo, N.; Wadowski, P.P. Myocardial Oedema as a Consequence of Viral Infection and Persistence—A Narrative Review with Focus on COVID-19 and Post COVID Sequelae. Viruses 2024, 16, 121.

Abstract

Microvascular integrity is a critical factor in myocardial fluid homeostasis. The subtle equilibrium between capillary filtration and lymphatic fluid removal is disturbed during pathological processes leading to inflammation, but also in hypoxia or due to alterations in vascular perfusion and coagulability. The degradation of the glycocalyx as the main component of the endothelial filtration barrier as well as pericyte disintegration result in accumulation of interstitial and intracellular water. Moreover, lymphatic dysfunction evokes an increase in metabolic waste products, cytokines and inflammatory cells in the interstitial space contributing to myocardial oedema formation. This leads to myocardial stiffness and impaired contractility eventually resulting in cardiomyocyte apoptosis, myocardial remodelling and fibrosis. The following article reviews pathophysiological inflammatory processes leading to myocardial oedema including myocarditis, ischaemia-reperfusion injury and viral infections with a special focus on the pathomechanisms evoked by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In addition, clinical implications including potential long-term effects due to viral persistence (long-COVID), as well as treatment options are discussed.

Keywords

myocardial oedema; glycocalyx; coronavirus disease 2019; microcirculation; platelets

Subject

Medicine and Pharmacology, Cardiac and Cardiovascular Systems

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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