Cardiovascular disease in COVID-19: a systematic review and meta-analysis of 10,898 patients and proposal of a triage risk stratification tool

Abstract

Background: Coronavirus disease 2019 (COVID-19) pandemic has drastically affected global health. Despite several studies, there is yet a dearth of data regarding the mechanisms of cardiac injury, clinical presentation, risk factors, and treatment of COVID-19-associated cardiovascular disease. This systematic review and meta-analysis is aimed at defining the clinical, electrocardiographic, and pathologic spectrum of cardiovascular disease (CVD), frequency of elevated cardiac and inflammatory biomarkers, and their frequency and relationship with severity of the disease and mortality in COVID-19 patients and to develop a triage risk stratification tool (TRST) that can serve as a guide for the timely recognition of the high-risk patients and mechanism-targeted therapy. We conducted an online search in databases of PubMed and Embase to identify relevant studies. Data selection was in concordance with PRISMA guidelines. Results were presented as pooled frequencies, odds ratio, standardized mean difference (SMD), and forest and funnel plots. Results: We gathered a total of 54 studies and included 35 of them in our meta-analysis. Acute cardiac injury occurred in more than 25% of cases, mortality was 20 times higher, and admission to intensive care unit increased by 13.5 times. Hypertension was the most common pre-existing comorbidity with a frequency of 29.2%, followed by diabetes mellitus (13.5%). The deceased group of patients had higher cardiac and inflammatory biomarkers, with statistically significant SMD, compared with survivors. Pediatric patients were predominantly mildly affected. However, less frequently, the presentation was very similar to Kawasaki disease or Kawasaki shock syndrome. This latter presentation hass been called as multisystem inflammatory syndrome in children (MIS-C). Conclusions: There is a wide spectrum of cardiac involvement in COVID-19 patients, and hence a Triage Risk Stratification Tool can serve as a guide for the timely recognition of the high-risk patients and mechanism-targeted therapy.

Type I Interferon Limits Viral Dissemination-Driven Clinical Heterogeneity in a Native Murine Betacoronavirus Model of COVID-19

“…Animals also developed evidence of hepatic damage ( Figure 2D), another common finding in COVID-19 associated with mortality (Hundt et al, 2020). Based on serum troponin elevation, some animals also showed evidence of cardiac injury (Figure 2E), which is a common manifestation in COVID-19 patients (Momtazmanesh et al, 2020). All animals displayed evidence of systemic inflammation ( Figure 2F-I), reminiscent of a "cytokine storm," similar to what is observed in COVID-19 (Lucas et al, 2020;Ragab et al, 2020); circulating levels of tumor necrosis factorα (TNF-α), interleukin-6 (IL-6), and interferon-α (IFN-α) peaked at 6 dpi, when viral loads in the lung were decreasing, except for interferon-β (IFN-β), which peaked at 3 dpi.…”

Pleural diseases and COVID-19: ubi fumus, ibi ignis

“…It may be argued that most, if not all, of these pleural effusions may be secondary to comorbid conditions rather than being directly related to the viral infection. About half of COVID-19 patients have comorbidities [ 12 , 13 ], including pre-existing cardiovascular diseases (12.6%) or heart failure (6.5%) [ 14 ]. Moreover, more than 25% of infected patients exhibit myocardial injury of potential inflammatory pathogenesis (a cause of impaired cardiac function) as demonstrated by elevation of troponin T levels [ 14 ] and, at least 20% develop heart failure during disease course [ 15 ].…”

“…About half of COVID-19 patients have comorbidities [ 12 , 13 ], including pre-existing cardiovascular diseases (12.6%) or heart failure (6.5%) [ 14 ]. Moreover, more than 25% of infected patients exhibit myocardial injury of potential inflammatory pathogenesis (a cause of impaired cardiac function) as demonstrated by elevation of troponin T levels [ 14 ] and, at least 20% develop heart failure during disease course [ 15 ]. On the other hand, the incidence of pulmonary embolism was 8.3% among 1240 infected patients who were subjected to a CT pulmonary angiography [ 16 ].…”

Cardiac Arrhythmias in Patients with COVID-19: A Systematic review and Meta-analysis

“…Previous studies has showed that compared to different systems, the cardiovascular system is considered the second most commonly affected organ by COVID-19 after the respiratory system 2,[5][6][7][8]23 . The results of this systematic review and meta-analysis showed that cardiac arrhythmia occurred frequently in patients with COVID-19 with incidence exceeding 19% of the total cases with covid-19.…”

“…In our study, the cumulative number of patients with both arrhythmia and COVID-19 was 269 out of 1445 patients with COVID-19 which is slightly of higher percentage than Wang et al 2 . It is known from previous meta-analyses that baseline characteristics such as sex, hypertension, and diabetes can affect the outcomes of the pooled studies [23][24][25][26][27] but the metaregression option was not available to assess the exact effect of those factors given that the number of the included studies was less than 10.…”