COVID-19 is shown to impact the heart and, in some cases, have long-lasting cardiac effects. To discover the extent to which COVID-19 affects the heart, cardiologists and researchers with the University of Miami Miller School of Medicine have begun multiple studies.
“We are conducting data and laboratory studies that could eventually lead to potential treatments for coronavirus-related heart problems,” said Jeffrey Goldberger, M.D., M.B.A., professor of medicine and chief of the Cardiovascular Division.
The Miller School is collaborating with other U.S. cardiovascular programs examining connections between COVID-19 and myocardial infarctions (MIs) or heart attacks. “We will be participating in the North American COVID-19 and MI registry to study the treatment of patients with confirmed or presumptive COVID-19 who suffer an acute myocardial infarction,” said Dr. Goldberger. “We will also be collaborating with the American Heart Association (AHA) on a COVID-19 registry to identify the best practices, quality measures, and treatments for patients with COVID-19 and cardiovascular diseases.”
The research accompanies the University’s recently announced COVID-19 Heart Program, which is aimed at identifying and diagnosing serious conditions related to COVID-19 at an early stage and protecting the heart from serious damage.
The Miller School’s clinical research team includes Carlos E. Alfonso, M.D., associate professor of medicine, director of advanced interventional cardiology and director of the Cardiovascular Fellowship Program; Mauricio G. Cohen, M.D., professor of medicine and director of the Cardiac Catheterization Laboratory; and Raul D. Mitrani. M.D., professor of clinical medicine, director of clinical cardiac electrophysiology and director of the Electrophysiology Fellowship Program.
For instance, Dr. Mitrani is collaborating with Dr. Goldberger on a follow-up study of COVID-19 survivors to assess arrhythmia risk.
“Approximately 25 percent of COVID-19 patients with severe lung disease also appear to have an inflammation of the heart called myocarditis,” said Dr. Mitrani. “Based on prior studies of viral-related myocardial injuries, it is likely that COVID-19 will have some type of impact on the heart leading to cardiovascular abnormalities, such as coronary artery disease, atrial fibrillation or ventricular arrhythmias.”
To help answer that question, Leonardo Tamariz, M.D., M.P.H., professor of medicine, is evaluating if patients with less severe forms of coronavirus have any level of heart damage as indicated by blood tests and cardiac imaging.
Another study involves patients with hypertension and other cardiovascular conditions who are taking two types of medications: angiotensin converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB). “It is uncertain if these drugs play a role in regard to COVID-19 infection since the virus uses the ACE2 receptor to enter the cells,” said Dr. Goldberger. He noted that Miller School researchers hope to participate and enroll patients in a randomized trial now under way at the University of Pennsylvania led by a UM graduate, Julio Chirinos, M.D., and other investigators.
Other Miller School researchers are digging into COVID-19 from the biological side, hoping to gain a better understanding of the viral infection process. For instance, Lina Shehadeh, Ph.D., associate professor of medicine in the Division of Cardiology and the Interdisciplinary Stem Cell Institute, is working on identifying new mechanisms for coronaviral entry into the cells and blocking these infection mechanisms by repurposing existing drugs.
Robert J. Myerburg, M.D., professor of medicine and physiology, is also planning a new biomarker study with UM cardiologist Chunming Dong, M.D., professor of medicine. They will use sophisticated statistical and bioinformatical analyses to predict COVID-19 disease course and severity.
“This study would allow for appropriate patient triage and efficient utilization of health care resources,” said Dr. Myerburg. “It would also provide new insights on the pathogenesis of COVID-19.”