Cardiovascular complications in Covid-19: a comparative study of clinical characteristics and their effect on the outcome of first wave and second wave

Abstract

Funding Acknowledgements Type of funding sources: None. Introduction SARS-CoV-2 is 30 kb long, positive sense, single stranded and polyadenylated.(1)SARS-CoV-2 has tight interaction with the human ACE2 receptor binding domain, causing greater transmissibility.(2) SARS-CoV-2 viral particles have been seen by RT-PCR in cardiac tissue(3)supporting direct cardiotoxicity.Hyperinflammation leads to vascular inflammation, plaque instability, myocardial inflammation and suppression(4,5) The most common symptoms include breathlessness, fever, dry cough.(6,7) Aims This retrospective observational study included 120 positive patients tested by RT-PCR(kit used- Blackbio TruPCR Kilpest) or TrueNAT (kit used-chip based Covid-19 PCR by Molbio diagnostics)tests, admitted to CMC,Ludhiana over two years. 60 patients from first wave (March 2020-December 2020) and 60 patients from second wave (January 2021-May 2021). The aim is to study the clinical symptoms, the nature and outcome of patients who had CVS complications during hospital stay in first and second waves. Statistical analysis- Data were described in range; mean ±standard deviation (± SD),and frequencies.Kolmogorov-Smirnov test was used. Comparison of quantitative variables between the study groups was done using Student t-test and Mann Whitney U test.For comparing categorical data, Chi square (χ2) test was done and p value less than 0.05 was considered statistically significant. Results In 2020,35(58%) were males compared to 63%(38)in the second.The mean age was >50years in both the waves.In 2020,20(33%) had hypertension and 16(27%) patients in 2021.Diabetes accounted for 16(27%) in the first wave and 10(17%) in the second.14(23%) of the patients in first wave and 10(17%) of the patients in second wave had CAD.The most common symptom was breathlessness seen in 26(43%) patients of first and 32(53%) of second wave. Fever was seen in 26(43%) of patients in the first and 22 (37%) in the second.11(18%) of patients in both the years had cough.7(12%) patients last year and 11(18%) patients this year had sore throat.4(7%) patients of the first wave and 11(18%) patients of the second wave had chest pain.STEMI was seen in 13(22%) patients in the second wave. Unstable angina accounted for 17%(10) patients in the first wave.Arrhythmia accounted for 6(10%) patients in 2020 and 12(20%) patients in 2021.NSTEMI was seen in 6(10%) patients of the first wave and 2(3%) patients in the second wave.4(7%) patients last year presented in acute LVF.22(37%) patients having cardiovascular complications last year and 2(35%) patients this year died. 26 (43%) patients in both the years were discharged. Conclusions There was no statistical significance between the two waves.The outcome of patients with co morbidities was worse than the ones without them.Both the waves had almost equal number of mortalities.The guards should not be let down since the severity of both the waves was similar.Knowing about the disease, one can anticipate its nature and course in the times to come.