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NEW INSIGHTS ON THE MECHANISMS OF MYOCARDIAL INJURY IN HYPERTENSIVE PATIENTS WITH COVID‑19
Moll‑Bernardes, Renata et al. | Date Issued: 2023
Author
Moll‑Bernardes, Renata
Ferreira, Juliana R.
Schaustz, Eduardo B.
Sousa, Andréa S.
Mattos, João D.
Tortelly, Mariana B.
Pimentel, Adriana L.
Figueiredo, Ana Cristina B. S.
Noya-Rabelo, Marcia M.
Fortier, Sergio
Silva, Flavia A. Matos e
Vera, Narendra
Conde, Luciana
Cabral‑Castro, Mauro Jorge
Albuquerque, Denilson C.
Rosado‑de‑Castro, Paulo Henrique
Camargo, Gabriel C.
Pinheiro, Martha V. T.
Freitas, Daniele O. L.
Pittella, Ana M.
Araújo, José Afonso M.
Marques, André C.
Gouvêa, Elias P.
Terzi, Flavia V. O.
Zukowski, Cleverson N.
Gismondi, Ronaldo A. O. C.
Bandeira, Bruno S.
Oliveira, Renée S.
Abufaiad, Barbara E. J.
Miranda, Jacqueline S. S.
Miranda, Luiz Guilherme
Souza, Olga F.
Bozza, Fernando A.
Luiz, Ronir R.
Medei, Emiliano
Affilliation
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Rede D'Or São Luiz. Cardiology and Internal Medicine Department. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Disease. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Rede D'Or São Luiz. Cardiology and Internal Medicine Department. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Rede D'Or São Luiz. Cardiology and Internal Medicine Department. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Rede D'Or São Luiz. Cardiology and Internal Medicine Department. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Rede D'Or São Luiz. Cardiology and Internal Medicine Department. Rio de Janeiro, RJ, Brazil / Bahia School of Medicine and Public Health. Salvador, BA, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Institute of Biophysics Carlos Chagas Filho. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Institute of Biophysics Carlos Chagas Filho. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Institute of Microbiology Paulo de Góes. Rio de Janeiro, RJ, Brazil / Fluminense Federal University. Faculty of Medicine. Department of Pathology. Niterói, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Rio de Janeiro State University. Cardiology Department. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Rede D'Or São Luiz. Cardiology and Internal Medicine Department. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Rede D'Or São Luiz. Cardiology and Internal Medicine Department. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Rede D'Or São Luiz. Cardiology and Internal Medicine Department. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Rede D'Or São Luiz. Cardiology and Internal Medicine Department. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Rede D'Or São Luiz. Cardiology and Internal Medicine Department. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Rede D'Or São Luiz. Cardiology and Internal Medicine Department. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Rede D'Or São Luiz. Cardiology and Internal Medicine Department. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Rede D'Or São Luiz. Cardiology and Internal Medicine Department. Rio de Janeiro, RJ, Brazil / Federal University of the State of Rio de Janeiro. Internal Medicine Department. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Rede D'Or São Luiz. Cardiology and Internal Medicine Department. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Rede D'Or São Luiz. Cardiology and Internal Medicine Department. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Rede D'Or São Luiz. Cardiology and Internal Medicine Department. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Rede D'Or São Luiz. Cardiology and Internal Medicine Department. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Disease. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Federal University of Rio de Janeiro. Institute for Studies in Public Health. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil / Federal University of Rio de Janeiro. Institute of Biophysics Carlos Chagas Filho. Rio de Janeiro. RJ, Brazil / Federal University of Rio de Janeiro. National Center for Structural Biology and Bioimaging. Rio de Janeiro, RJ, Brazil.
Abstract
Purpose: Myocardial injury is common in hypertensive patients with 2019 coronavirus disease (COVID-19). Immune dysregulation could be associated to cardiac injury in these patients, but the underlying mechanism has not been fully elucidated. Methods: All patients were selected prospectively from a multicenter registry of adults hospitalized with confrmed COVID19. Cases had hypertension and myocardial injury, defned by troponin levels above the 99th percentile upper reference limit, and controls were hypertensive patients with no myocardial injury. Biomarkers and immune cell subsets were quantifed and compared between the two groups. A multiple logistic regression model was used to analyze the associations of clinical and immune variables with myocardial injury. Results: The sample comprised 193 patients divided into two groups: 47 cases and 146 controls. Relative to controls, cases had lower total lymphocyte count, percentage of T lymphocytes, CD8+CD38+ mean fuorescence intensity (MFI), and percentage of CD8+ human leukocyte antigen DR isotope (HLA-DR)+ CD38–cells and higher percentage of natural killer lymphocytes, natural killer group 2A (NKG2A)+ MFI, percentage of CD8+CD38+cells, CD8+HLA-DR+MFI, CD8+NKG2A+MFI, and percentage of CD8+HLA-DR–CD38+cells. On multivariate regression, the CD8+HLA-DR+MFI, CD8+CD38+MFI, and total lymphocyte count were associated signifcantly with myocardial injury. Conclusion: Our fndings suggest that lymphopenia, CD8+CD38+MFI, and CD8+HLA-DR+MFI are immune biomarkers of myocardial injury in hypertensive patients with COVID-19. The immune signature described here may aid in understanding the mechanisms underlying myocardial injury in these patients. The study data might open a new window for improvement in the treatment of hypertensive patients with COVID-19 and myocardial injury.
Keywords
Troponin
Myocardial Injury
Hypertension
Immune System
COVID-19
 
Publisher
Springer
Citation
MOLL-BERNARDES, Renata et al. New Insights on the Mechanisms of Myocardial Injury in Hypertensive Patients With COVID‑19. Journal of Clinical Immunology, v. 43, n. 7, p.1496-1505, Oct. 2023.
DOI
10.1007/s10875-023-01523-6
ISSN
0271-9142