Cardiac damage in patients with the severe type of coronavirus disease 2019 (COVID-19)

Abstract

Background Coronavirus disease 2019 (COVID-19) has become a global pandemic. Studies showed COVID-19 affected not only the lung but also other organs. In this study, we aimed to explore the cardiac damage in patients with COVID-19. Methods We collected data of 100 patients diagnosed as severe type of COVID-19 from February 8 to April 10, 2020, including demographics, illness history, physical examination, laboratory test, and treatment. In-hospital mortality were observed. Cardiac damage was defined as plasma hypersensitive troponin I (hsTnI) over 34.2 pg/ml and/or N-terminal-pro brain natriuretic peptide (NTproBNP) above 450 pg/ml at the age < 50, above 900 pg/ml at the age < 75, or above 1800 pg/ml at the age ≥ 75. Results The median age of the patients was 62.0 years old. 69 (69.0%) had comorbidities, mainly presenting hypertension, diabetes, and cardiovascular disease. Fever (69 [69.0%]), cough (63 [63.0%]), chest distress (13 [13.0%]), and fatigue (12 [12.0%]) were the common initial symptoms. Cardiac damage occurred in 25 patients. In the subgroups, hsTnI was significantly higher in elder patients (≥ 60 years) than in the young (median [IQR], 5.2 [2.2–12.8] vs. 1.9 [1.9–6.2], p = 0.018) and was higher in men than in women (4.2 [1.9–12.8] vs. 2.9 [1.9–7.4], p = 0.018). The prevalence of increased NTproBNP was significantly higher in men than in women (32.1% vs. 9.1%, p = 0.006), but was similar between the elder and young patients (20.0% vs. 25.0%, p = 0.554). After multivariable analysis, male and hypertension were the risk factors of cardiac damage. The mortality was 4.0%. Conclusions Cardiac damage exists in patients with the severe type of COVID-19, especially in male patients with hypertension. Clinicians should pay more attention to cardiac damage.

Current status of the COVID‐19 and male reproduction: A review of the literature

“…[19][20][21] Nevertheless, other organs are also known to be damaged by the virus. [22][23][24][25][26] As for human reproduction, concerns of potential vertical transmission have been raised. 27 Human embryos present all of the machinery needed for SARS-CoV-2 binding, internalization, and replication, suggesting that "in theory" viral infection may compromise embryonic and fetal development.…”

“…Extensive literature reveals that the lungs of SARS patients are commonly the most affected organs, with severe degeneration of the epithelium 19‐21 . Nevertheless, other organs are also known to be damaged by the virus 22‐26 …”

“…20 Considering the tens of millions of COVID-19 cases and that men are more vulnerable to COVID-19 than women, [21][22][23] it is imperative to determine the effect of COVID-19 on male reproduction. 24 Several studies have been performed on this topic. However, the results are controversial.…”

Evaluation of High-Sensitivity Cardiac Troponin T Levels in Japanese Patients Recently Recovered From Coronavirus Disease 2019

“…A study performed in China reported that cardiac damage was more likely in male patients with hypertension. 16 A meta-analysis of 16 studies revealed that the incidence of cardiac injury was 24.4% in hospitalized COVID-19 patients. In subgroup analyses, factors such as older age, hypertension, and chronic obstructive respiratory disease were associated with an increased risk of developing a cardiac injury.…”

The vicious cycle: a history of obesity and COVID-19

“…Li et al analyzed data of 100 subjects with a severe type of COVID-19 [ 2 ]. The multivariable analysis found that male sex (HR 5.09, 95% CI 1.19–22.17) and hypertension (HR 9.88, 95% CI 2.52–28.70) were the risk factors of cardiac injury.…”