IJCS | Volume 33, Nº4, July and August 2020

DOI: https://doi.org/10.36660/ijcs.202000164 Introduction The ongoing pandemic of Severe Acute Respiratory Virus-2 (SARS-CoV2) infection was first recognized in China in 2019 and brought significant health and economic threats around the world. On January 31, 2020, the World Health Organization (WHO) declared the disease caused by SARS-CoV2 an international public health emergency and on March 11, 2020, the WHO declared it a pandemic. 1,2 Three months after the initial WHO declaration, there are more than 5 million confirmed cases worldwide and 300,000 deaths. In Brazil, in the same time interval, there were more than 850,000 cases and 43,000 deaths, with an upward trend. 3 The epidemiological and clinical severity of the pandemic by COVID-19 was initially supported by 4 alarming elements: (a) respiratory transmission with a high infectivity rate; (b) high lethality in specific subgroups; (c) high demand for intensive care and mechanical ventilation; and (d) no effective vaccine or specific treatment. Given the magnitude of the problem and the scarcity of resources, there was a recommendation for hospitalizing critically ill patients andproviding themwith supportive treatment and, above all, mitigation via social isolation aimed at flattening out the epidemic curve. 4-12 COVID-19 and cardiovascular diseases Among the various clinical manifestations of COVID-19, cardiovascular complications are one of the most significant and with a potential risk of mortality. COVID-19 may present with respiratory failure secondary to pneumonia; acute respiratory distress syndrome; and severe cardiac injury characterized by high troponin and heart failure (HF). This presentation is associated with increased mortality. The COVID-19 pandemic imposes a double burden on people with cardiovascular disease (CVD). About 40% of patients hospitalized with COVID-19 have CVD with a worse clinical outcome. Many of the most severe manifestations, such as myocardial injury, can occur between 8 and 14 days after the onset of symptoms. Several observational studies fromChinese and European series have identified advanced age and the presence of comorbidities, such as diabetes, hypertension, atherosclerotic coronary disease (CAD), and chronic obstructive pulmonary disease (COPD), as predictors of progression to severe illnesses, with higher lethality. The increase in the frequency of adverse cardiovascular events after the resolution of COVID-19, similar to other viral infections such as influenza, may also play a role in mortatily of patients with. COVID-19. Thus, understanding the relationshipbetween the immune response of the viral host and the cardiovascular system will be extremely important in the care and treatment of patientswithCOVID-19. 13 Several mechanisms are related to cardiac injury in patients with COVID-19, such as direct viral myocardial injury, microvascular injury, stress cardiomyopathy (Takotsubo), acute coronary syndrome, myocardial injury due to an imbalance in oxygen supply and demand, and systemic inflammatory response with myocardial injury. 14 This could be specially deleterious in patients with HF with preserved ejection fraction (HFpEF), in whom baseline diseases such as diabetes and hypertension are prevalent (Figure 1). 412 VIEWPOINT International Journal of Cardiovascular Sciences. 2020; 33(4):412-418 Mailing Address: Antonio Jose Lagoeiro Jorge Universidade Federal Fluminense - Clinica Médica Av. Marquês do Paraná, 303 - Centro. Postal code: 24033-900, Niterói, RJ – Brazil. E-mail: lagoeiro@globo.com Heart Failure with Preserved Ejection Fraction and COVID-19: a Pernicious Relationship Evandro Tinoco Mesquita, 1,3 Antonio Jose Lagoeiro Jorge, 1 H umberto Villacorta, 1 L uiz Claudio Danzmann, 2 Wolney de Andrade Martins 1 Universidade Federal Fluminense, 1 Niterói, RJ – Brazil. Universidade Luterana do Brasil, 2 Canoas, RS – Brazil. Centro de Ensino e Treinamento Edson de Godoy Bueno / UHG, 3 Rio de Janeiro, RJ – Brazil. Manuscript received June 8, 2020; revised manuscript June 15, 2020; accepted June 26, 2020. Cardiovascular Diseases/complications; Heart Failure/ complications; Stroke Volume; Coronavirus; COVID-19; Pandemics; Mortality; Pneumonia. Keywords