Cardiac Complications in COVID-19: A Systematic Review and Meta-analysis

Abstract

Background: The newly emerged coronavirus disease 2019 (COVID-19) seems to involve different organs, including the cardiovascular system. We systematically reviewed COVID-19 cardiac complications and calculated their pooled incidences. Secondarily, we compared the cardiac troponin I (cTnI) level between the surviving and expired patients. Methods: A systematic search was conducted for manuscripts published from December 1, 2019 to April 16, 2020. Cardiovascular complications, along with the levels of cTnI, creatine kinase (CK), and creatine kinase MB (CK-MB) in hospitalized PCR-confirmed COVID-19 patients were extracted. The pooled incidences of the extracted data were calculated, and the unadjusted cTnI level was compared between the surviving and expired patients. Results: Out of 1094 obtained records, 22 studies on a total of 4,157 patients were included. The pooled incidence rate of arrhythmia was 10.11%. Furthermore, myocardial injury had a pooled incidence of 17.85%, and finally, the pooled incidence for heart failure was 22.34%. The pooled incidence rates of cTnI, CK-MB, and CK elevations were also reported at 15.16%, 10.92%, and 12.99%, respectively. Moreover, the pooled level of unadjusted cTnI was significantly higher in expired cases compared with the surviving (mean difference = 31.818, 95% CI = 17.923-45.713, P value <0.001). Conclusion: COVID-19 can affect different parts of the heart; however, the myocardium is more involved.

Incidence of cardiac complications following COVID-19 infection: An umbrella meta-analysis study

“…The literature search provided 810 reviews, 40 of which were eligible for full-text review. After reviewing the full text, 26 meta-analysis studies were eligible for inclusion 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 . The study selection process is shown in Fig.…”

“…All studies were published during the current COVID-19 outbreak. Studies were limited mainly to China 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , then the USA 22 , 27 , 31 , 32 followed by Italy 31 , 32 . The general characteristics of the studies are shown in Table 1 .…”

“… PubMed and Embase; January 1, 2020, - May 30, 2020 16 studies, Prospective(2), Retrospective (14) China(14), Italy(1), and the United States (1) High 2224 patients 17 Wen et al 17 Evaluating arrhythmia in patients with severe and non-severe COVID-19 PubMed, Embase, Web of Science, and the Cochrane Library; December 2019 - July 25, 2020 5 studies, (N/R) N/R Moderate 1553 patients, 349 severely ill and 1204 non-severely ill 18 Vakhshoori et al 18 Analyzing the effect of COVID-19 on acute miyocardial injury Medline/PubMed, Scopus, and Google Scholar; December 2019 - March 25, 2020 11 studies, all cross-sectional designs All China High 1394 patients 19 Tondas et al 19 Assessing electrocardiographic (ECG) ventricular repolarization indices in patients with COVID-19. PubMed, EuropePMC, SCOPUS, Cochrane Central Database, and Google Scholar; N/R 2 studies, two case-control N/R moderate 241 patients 20 Toloui et al 20 Assessing the prevalence of cardiac complications and the resulting mortality rate in COVID-19 patients Medline (using PubMed), Embase, Scopus, and Web of Science, Google and Google scholar; 2019 until April 30th, 2020 40 studies, Two: One: Ambispective, four: prospective, 35 studies were retrospective the United States, one: Spain, one: Italy, the Rest: China High 15616 patients 21 Sinclair et al 21 Assessing cmorbidities in COVID-19 patients. PubMed, Embase, medRxiv, and SSRN; Dec 1, 2019 - October 14, 2020, 29 studies China 10, Iran 1, German 1, Italy 6, turkey 1, us 5, France 1, Israel 1, spine 1 High 3508 patients 22 Pranata et al 22 Evaluating the incidence of cardiac arrhythmias in patients with COVID-19 PubMed, SCOPUS, Europe PMC, Cochrane ...…”

“…Several systematic reviews and meta-analysis studies related to diverse cardiovascular complications following COVID-19 disease have been published so far 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 . However, as the number of individual review studies increases, clinical practitioners may find it difficult to keep track of information 33 .…”

Clinical Findings and Prognosis of COVID-19 Patients with Benign Prostatic Hyperplasia: A Case Series

“…The severity of symptoms and the patients' prognosis are function of patients' health condition, demographic and socioeconomic features. Therefore, it is important to evaluate the possible factors associated with the prognosis of COVID-19 patients [17][18][19].…”