Coronavirus disease 2019 (COVID-19) has reached pandemic proportions. While its prevalent manifestation and cause of death is severe acute respiratory syndrome (SARS), increasing evidence indicates that patients with pre-existing cardiovascular disease (CVD) and cardiac risk factors, such as ageing, hypertension, and diabetes mellitus, are more severely affected by the SARS coronavirus 2 (SARS-CoV-2) in terms of both morbidity and mortality.
It has already been reported that during acute viral infections, patients with coronary artery disease (CAD) are predisposed to acute coronary syndrome (ACS) resulting from the severe increase in myocardial demand and/or atherosclerotic plaque instability and rupture caused by the increased cytokine levels.1,2 The first reports from Chinese hospitals inundated with COVID-19 cases confirm the association between pre-existing CVD, diabetes, and ageing with COVID-19-induced myocardial injury (determined by elevated cardiac troponin levels) and in-hospital deaths.3, 4 It is also emerging that CoV-2 can induce myocarditis and myocardial infarction in otherwise healthy subjects.
The personal and professional lives of many clinical and non-clinical cardiovascular scientists and healthcare providers have been revolutionized, with some working impossible shifts in the intensive care units (ICUs) and others in lockdown, leading to instant messaging chatrooms, teleconferencing, webinars, and similar tools to stay connected. The outpatient clinics and elective treatments of many cardiovascular patients are collaterally impaired, and emerging alarming data suggest that patients in urgent need of revascularization procedures are delaying the moment to go to hospital because of COVID-19 fears.
For the medical scientific community, policy makers, and granting agencies, this is the moment to act decisively, and coordinated actions are urgently needed. Whilst attention is now rightly on minimizing deaths (including cardiovascular death) in the ICU, we believe that the COVID-19 crisis will have a memory, with longer term residual repercussions on the cardiovascular system.
In the immediate scenario, more epidemiological, clinical, and basic research is urgently needed to understand the different mechanisms underlying the association between CVD and COVID-19, and there is a need to discuss the future use of current drugs used in cardiovascular patients, as well as fully understanding the cardiovascular impact of new or repurposed drug design to combat the CoV-2 infection.5
Moreover, we hypothesize that similar to what happens following a myocardial infarct, chemotherapy, and radiotherapy, some of the patients who survive COVID-19 will present with long-lasting cardiovascular damage and might be exposed to the risk of progressively developing heart failure and vascular disease. It will be imperative therefore to understand the mechanisms implicated and to develop clinical cardiovascular biomarkers allowing for effective future management of such patients.
To help address these issues, we are offering the EU-CardioRNA COST action CA17129 (www.cardiorna.eu )), an international group of clinical and non-clinical scientists. COST actions are networking instruments aimed at creating a collaborative and interdisciplinary European consortium that can also assemble scientists operating beyond Europe. EU-CardioRNA is comprised of 31 European members and 6 international partner countries, including the USA, Russia, and Singapore. Our consortium focuses on CVD transcriptomics and circulating RNA biomarkers.
We have already launched an internal initiative to map individual research expertise and capacity of relevance for COVID-19. This includes clinical samples and data collection across our hospitals, e.g. nationalized collections such as the UK-ISARIC platform (https://isaric.tghn.org/covid-19-clinical-research-resources/). We are also inviting harmonization of the protocols for sample collection, processing (in the case of prospective collection), and banking. We are becoming aware that scientists based in different countries have access to different types of COVID-19 and control cohorts (from ICU to general population testing), enabling better insights on the situation at different follow-up times.
Consequently, we would like to engage and collaborate with other researchers and Institutes with similar goals. Any interest in collaborating in building a multicentre study on cardiovascular RNA biomarkers in SARS-CoV-2-infected patients should be directed to the corresponding authors.
We also intend to encourage national and international grant agencies to further open calls for truly international partnerships, conferring optimal research capacity to our and other multinational and multidisciplinary groups.
Costanza Emanueli1*, Lina Badimon2, Fabio Martelli3, Ines Potočnjak4, Irina Carpusca5, Emma L. Robinson6, Yvan Devaux;5* on behalf of the EU-CardioRNA COST Action (CA17129)
1National Heart and Lung Institute, Imperial College London, London, UK; 2Cardiovascular Program (ICCC)-IR, Hospital de la Santa Creu i Sant Pau, CIBERCV, Barcelona, Spain; 3Molecular Cardiology Laboratory, Policlinico San Donato IRCCS, San Donato Milanese, Milan, Italy; 4Institute for clinical medical research and education, University Hospital Centre Sisters of Charity, Zagreb, Croatia; 5Cardiovascular Research Unit, Luxembourg Institute of Health, Strassen, Luxembourg; and 6Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
*Corresponding authors. National Heart and Lung Institute, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK. Tel: +44 207 5 943 409, Email: c.emanueli@imperial.ac.uk and Cardiovascular Research Unit, Luxembourg Institute of Health, 1A-B, rue Thomas Edison, 1445 Strassen, Luxembourg. Tel: +352 26 970 303, Email: yvan.devaux@lih.lu
Funding
This work is supported by COST (European Cooperation in Science and Technology) Action EU-CardioRNA CA17129.
Conflict of interest: none declared.
References
References are available as Supplementary material at European HeartJournal online.
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