Cardiac Injury and COVID-19: A Systematic Review and Meta-analysis

Abstract

Background: During the current COVID-19 pandemic, a link between acute cardiac injury and COVID-19 infection has been observed. There is currently no consensus on the incidence of cardiac injury, its relationship to prognosis, or its possible cause. In this article we provide a comprehensive review and meta-analysis of the incidence, comorbidities, outcomes, and possible mechanisms of acute cardiac injury in COVID-19 patients. Methods: We searched PubMed and Embase for studies that evaluated cardiac injury in hospitalized COVID-19 patients. Data on Therefore, the purpose of this study was to present a systematic review and meta-analysis of the literature to investigate the incidence of cardiac injury, its correlations with comorbidities and outcomes, and its possible mechanisms in the global COVID-19 population. Methods Data source and searchesWe performed a systematic literature search in PubMed and Embase. We used the following search terms: ("coronavirus") and ("cardiac injury" or "myocardial injury" or "myocarditis" or "troponin"). The search was limited to Chinese and English and all articles from January 1, 2020 to May 30, 2020 were reviewed. Study selection, data extraction, and definitionsOriginal studies that reported cardiac injury as elevated troponin levels were included. Review articles, meta-analysis and case reports were excluded. An aggregate data meta-analysis was performed. The extracted data included the number of patients enrolled in each study, age, sex, comorbidities (coronary artery disease [CAD], diabetes [DM], hypertension [HTN], and chronic obstructive pulmonary disease [COPD]), laboratory values (Creactive protein [CRP], procalcitonin, and N-terminal pro brain natriuretic peptide [NT-proBNP]), mortality, and other outcome CJC Open 2 (2020) 386e394

Myocardial Injury Is Associated with Higher Morbidity and Mortality in Patients with 2019 Novel Coronavirus Disease (COVID-19)

“…Among 143 patients with COVID-19, 31 (21.7%) who had significantly higher mortality. In cardiac injury group, the median duration from illness onset to death was 17.8 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] days; a figure that is comparable to published data in literature. Shi et al [14] described in a retrospective cohort of patients with COVID-19 that 19.7% had cardiac injury with mortality rate of 51.2% compared with 4.5% in non-cardiac injury group.…”

“…Cardiac injury is a common condition among COVID-19 hospitalized patients [ 6 ] and is associated with an increased risk of in-hospital mortality [ 7 ]. A recently published systemic review [ 8 ] looked at more than 10 studies from Italy, USA, and China, has highlighted that myocardial injury is not uncommon in setting of COVID-19, and can lead to higher mortality in hospitalized patients. Cappannoli et al [ 9 ] has described in a review that how patients with COVID-19 may share many characteristics with patients who have CVDs, making it often difficult to differentiate some clinical manifestations while explain why this infection is more severe in patients with underlying cardiovascular risk factors.…”

Prognostic Value of Troponin Elevation in COVID-19 Hospitalized Patients

“…However, a rise in Tn appears more accurate in predicting mortality compared to other biomarkers [ 14 , 17 ]. In a meta-analysis of 16 studies, Zou et al found a pooled overall incidence of myocardial injury of 24.4% (542/2224) and a markedly increased all-cause mortality associated with a rise in Tn (72.6% vs. 14.5%) [ 12 ]. Furthermore, in the largest study published to date on Tn as a predictor of death including 6247 COVID-19 patients, Majure et al observed significantly increased death rates in the case of Tn elevation compared to normal Tn levels (43% vs. 13%) [ 13 ].…”

“…The recent perception of COVID-19 as a systemic condition acting through multiple deleterious mechanisms, such as inflammation, endothelial dysfunction, prothrombotic state, and myocardial injury, could explain the severe course of the disease in some patients. The hypothetical mechanisms of myocardial injury include tissular hypoxia, cytokine storm, and direct viral myocardial lesions [ 1 , 12 , 18 ].…”

“…In March 2020, the American College of Cardiology suggested Tn measurement in the context of COVID-19 only if myocardial infarction was suspected [ 7 ]. Since then, myocardial injury has been described in approximately one-third of COVID-19 patients [ 8 , 9 , 10 , 11 , 12 , 13 ]. Recent publications have associated an elevation in cardiac and inflammatory biomarkers with infection severity and worse prognosis [ 13 , 14 ].…”