Challenges in Heart Disease in the Era of COVID-19

Dear Colleagues,

SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has spread rapidly throughout the world in the last two years, and several efforts since to reduce the mortality of coronavirus disease-19 (COVID-19).

Patients that tested positive for SARS-CoV-2 experienced COVID-19 with different stages of severity, ranging from asymptomatic patients to severe illness requiring intubation, mechanical ventilation and intensive care unit admission and possibly leading to death. Severe clinical manifestations are associated with hypercoagulative processes, acute thrombosis, over-inflammation and endothelial dysfunction. Notably, the case fatality rate seems higher in some patients, in particular among those with pre-existing comorbidities, such as cardiovascular disease (CVD). A combined effect of cardiovascular risk factors, such as obesity, hypertension and diabetes, may play a role in increasing illness and mortality during SARS-CoV-2 infection, as these conditions share several standard features with infectious disorders, including a chronic pro-inflammatory state and the attenuation of the innate immune response, which may make individuals more susceptible to disease complications. Moreover, in the presence of co-morbidities, a higher avidity of intramyocardial binding between Angiotensin Converting Enzyme 2 (ACE2) and SARS-CoV-2 has been described, with a consequent higher rate of myocarditis, cardiac complications, heart failure (HF) and deaths.

In this context, new therapeutic approaches for COVID-19 may reduce the cardiovascular effects and risk of mortality in COVID-19 patients, underlining the importance of a tailored treatment to protect high-risk patients. This Special Issue aims to collect a series of articles focused on current and future impacts of the COVID-19 pandemic on patients care, cardiovascular management and outcomes for patients with and without underlying cardiovascular disease and risk factors.

Finally, since "Long COVID", or post-acute sequelae of SARS-CoV-2 infection, has recently been found to present symptoms including fatigue, palpitations, chest pain, breathlessness, brain fog and dysautonomia, follow-up data of post-COVID-19 patients could be helpful to diagnose and treat this new nosological entity.

Dr. Federica Ilardi
Dr. Sara Cimino
Guest Editors

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• COVID-19
• cardiovascular disease
• cardiovascular risk factors
• cardiovascular Outcomes
• hypertension
• diabetes
• multi-morbidity
• long COVID-19