Clinical Characteristics and Risk Factors of Cardiac Involvement in COVID‐19

Abstract

Background Increasing studies demonstrated that the cardiac involvements are related to Coronavirus Disease 2019 (COVID‐19). Thus, we investigated the clinical characteristics of COVID‐19 patients and further determined the risk factors for cardiac involvements in them. Methods and Results We analyzed data from 102 consecutive laboratory‐confirmed and hospitalized COVID‐19 patients (52 women; age, 19–87 years). Epidemiological and demographic characteristics, clinical features, routine laboratory tests (including cardiac injury biomarkers), echocardiography, electrocardiography, chest imaging findings, management methods, and clinical outcomes were collected. Patients were divided into acute cardiac injury (ACI), with and without cardiac marker abnormities groups according to different level of cardiac markers. In this research, cardiac involvements were found in 72 of the 102 (70.6%) patients: tachycardia (n=20), electrocardiography abnormities (n=23), echocardiography abnormities (n=59), elevated myocardial enzymes (n=55), and acute myocardial injury (n=9). Eight ACI patients were aged >60 years; seven of them had two or more underlying comorbidities (hypertension, diabetes, cardiovascular diseases, chronic obstructive pulmonary disease and chronic kidney disease). Novel coronavirus pneumonia (NCP) was much more severe in the ACI patients than in patients with non‐definite ACI (p<0.001). Multivariate analyses showed that C‐reactive protein (CRP) levels, old age, NCP severity, and underlying comorbidities were the risk factors for cardiac abnormalities in COVID‐19 patients. Conclusions Cardiac involvements are common in COVID‐19 patients. Elevated CRP levels, old age, underlying comorbidities, and NCP severity are the main risk factors for cardiac involvement in COVID‐19 patients. More attention should be given to cardiovascular protection during COVID‐19 treatment for mortality reduction.

Role of Cardiac Macrophages on Cardiac Inflammation, Fibrosis and Tissue Repair

“…COVID19 patients frequently show significant myocardial damage as evidenced by elevated troponin-I levels, a biomarker of cardiac damage [ 68 , 69 , 70 ]. COVID19 patients may also present other cardiovascular complications, such as myocarditis, acute myocardial infarction, heart failure, arrhythmias, and venous thromboembolic events [ 69 , 71 , 72 ], and almost half of mildly ill COVID19 patients have abnormalities in heart function [ 73 , 74 , 75 , 76 ]. Together these clinical studies suggest that SARS-CoV2 can directly infect cells in the heart.…”

Clinical characteristics of COVID-19 with cardiac injury: a systematic review and meta-analysis

“…Statistically, hypertension (49.3%), diabetes (32.1%), CHD (28.8%) and COPD (8.8%) are common basic diseases in cardiac-injured patients, which are in line with the studies by Xu et al . [35]. Another multivariable logistic regression analysis also deemed CHD as a predictor of cardiac injury [36].…”

“…ARDS, AKI and AHI are common clinical complications in COVID-19 patients. A recent univariate analysis included these complications in risk factors for cardiac involvement [35] and meanwhile, Mohamad et al . found that the incidence of AKI and ARDS was positively correlated with the degree of cardiac injury [38].…”

COVID-19, hydroxychloroquine and sudden cardiac death: implications for clinical practice in patients with rheumatic diseases

“…A massive release of cytokines consequent to T-cell activation (IL-1, IL-10, IL-12, IL-6, IL-7, IFN-γ, TNF-α, CXCL10, CSF, etc.) may lead to direct myocardial fiber injury [ 9 – 11 , 29 , 41 , 46 , 51 , 52 ]. Cytokines such as TNF and IL-15 can directly induce myocardial fiber dysfunction, leading to stunning of the myocardium and poor contractile function [ 53 ].…”