Global burden of acute myocardial injury associated with COVID-19: A systematic review, meta-analysis, and meta-regression

Abate, Semagn Mekonnen; Mantefardo, Bahiru; Nega, Solomon; Chekole, Yigrem Ali; Basu, Bivash; Ahmed, Siraj; Taddesse, Moges

doi:10.1016/j.amsu.2021.102594

Cited by 23 publications

(27 citation statements)

References 91 publications

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“…Myocardial injury appears to be linked to severity of COVID-19 disease and mortality [ 4 – 10 ]. Mortality from COVID-19 is reported to be higher among hospitalized patients with myocardial injury, compared to those without, [ 4 , 6 , 7 , 11 , 12 ]. Indicating that myocardial injury may portend a poorer prognosis.…”

Section: Introductionmentioning

confidence: 99%

Incidence of acute myocardial injury and its association with left and right ventricular systolic dysfunction in critically ill COVID-19 patients

Jansson

Blixt

Didriksson

et al. 2022

Ann. Intensive Care

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Background Previous studies have found an increase in cardiac troponins (cTns) and echocardiographic abnormalities in patients with COVID-19 and reported their association with poor clinical outcomes. Whether acute injury occurs during the course of critical care and if it is associated with cardiac function is unknown. The purpose of this study was to document the incidence of acute myocardial injury (AMInj) and echocardiographically defined left ventricular (LV) and right ventricular (RV) systolic dysfunction in consecutive patients admitted to an intensive care unit (ICU) for COVID-19. The relationship between AMInj and echocardiographic abnormalities during the first 14 days of ICU admission was studied. Finally, the association between echocardiographic findings, AMInj and clinical outcome was evaluated. Methods Seventy-four consecutive patients (≥18 years) admitted to the ICU at Linköping University Hospital between 19 Mar 2020 and 31 Dec 2020 for COVID-19 were included. High-sensitivity troponin-T (hsTnT) was measured daily for up to 14 days. Transthoracic echocardiography was conducted within 72 h of ICU admission. Acute myocardial injury was defined as an increased hsTnT > 14ng/l and a > 20% absolute change with or without ischaemic symptoms. LV and RV systolic dysfunction was defined as at least 2 abnormal indicators of systolic function specified by consensus guidelines. Results Increased hsTnT was observed in 59% of patients at ICU admission, and 82% developed AMInj with peak levels at 8 (3–13) days after ICU admission. AMInj was not statistically significantly associated with 30-day mortality but was associated with an increased duration of invasive mechanical ventilation (10 (3–13) vs. 5 days (0–9), p=0.001) as well as ICU length of stay (LOS) (19.5 (11–28) vs. 7 days (5–13), p=0.015). After adjustment for SAPS-3 and admission SOFA score, the effect of AMInj was significant only for the duration of mechanical ventilation (p=0.030). The incidence of LV and RV dysfunction was 28% and 22%, respectively. Only indices of LV and RV longitudinal contractility (mitral and tricuspid annular plane systolic excursion) were associated with AMInj. Echocardiographic parameters were not associated with clinical outcome. Conclusions Myocardial injury is common in critically ill patients with COVID-19, with AMInj developing in more than 80% after ICU admission. In contrast, LV and RV dysfunction occurred in approximately one-quarter of patients. AMInj was associated with an increased need for mechanical ventilation and ICU LOS but neither AMInj nor ventricular dysfunction was significantly associated with mortality.

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Section: Introductionmentioning

confidence: 99%

Incidence of acute myocardial injury and its association with left and right ventricular systolic dysfunction in critically ill COVID-19 patients

Jansson

Blixt

Didriksson

et al. 2022

Ann. Intensive Care

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“…HF is among the most frequently reported cardiovascular complications related to COVID-19 infection, being diagnosed in up to 24% of patients, while venous thromboembolism was identified in 21% of cases, followed by dysrhythmias and myocarditis in 17% and 7% of patients, respectively [ 5 , 6 , 27 , 28 ]. The main risk factors for SARS-CoV-2-induced acute cardiac injury include smoking, male gender, and comorbidities, including diabetes mellitus, arterial hypertension, and coronary artery disease [ 10 , 11 ]. The imbalance between pro-inflammatory and anti-inflammatory mediators may be responsible for the development of major cardiovascular events [ 29 ].…”

Section: Cardiovascular Pathophysiology Related To Covid-19 and The M...mentioning

confidence: 99%

“…A plethora of studies show that approximately one in every three patients with COVID-19 will develop a certain phenotype of myocardial injury [ 7 , 12 , 13 ], the risk being significantly higher in patients with previously diagnosed chronic coronary heart disease [ 14 ]. Additional supporting evidence concerning acute cardiac injury due to coronavirus infection was provided by a large meta-analysis performed by Abate et al which reported an alarming 22.3% prevalence of myocardial injury in patients who tested positive for SARS-CoV-2 [ 10 ].…”

Section: Introductionmentioning

confidence: 95%

“…However, one should consider that a personal history of cardiovascular disease and elevated levels of cTn are factors of poor prognosis, being significantly associated with an increased risk of mortality in patients hospitalized with COVID-19. Specifically, two meta-analyses reported an 8 to 21-fold higher risk of fatal events in patients with SARS-CoV-2-related acute cardiac injury [ 10 , 11 ]. A plethora of studies show that approximately one in every three patients with COVID-19 will develop a certain phenotype of myocardial injury [ 7 , 12 , 13 ], the risk being significantly higher in patients with previously diagnosed chronic coronary heart disease [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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A Real Pandora’s Box in Pandemic Times: A Narrative Review on the Acute Cardiac Injury Due to COVID-19

Timpau

Miftode

Leca

et al. 2022

Life

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The intricate relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the cardiovascular system is an extensively studied pandemic topic, as there is an ever-increasing amount of evidence that reports a high prevalence of acute cardiac injury in the context of viral infection. In patients with Coronavirus disease 2019, COVID-19, a significant increase in serum levels of cardiac troponin or other various biomarkers was observed, suggesting acute cardiac injury, thus predicting both a severe course of the disease and a poor outcome. Pathogenesis of acute cardiac injury is not yet completely elucidated, though several mechanisms are allegedly involved, such as a direct cardiomyocyte injury, oxygen supply-demand inequity caused by hypoxia, several active myocardial depressant factors during sepsis, and endothelial dysfunction due to the hyperinflammatory status. Moreover, the increased levels of plasma cytokines and catecholamines and a significantly enhanced prothrombotic environment may lead to the destabilization and rupture of atheroma plaques, subsequently triggering an acute coronary syndrome. In the present review, we focus on describing the epidemiology, pathogenesis, and role of biomarkers in the diagnosis and prognosis of patients with acute cardiac injury in the setting of the COVID-19 pandemic. We also explore some novel therapeutic strategies involving immunomodulatory therapy, as well as their role in preventing a severe form of the disease, with both the short-term outcome and the long-term cardiovascular sequelae being equally important in patients with SARS-CoV-2 induced acute cardiac injury.

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“…Furthermore, experts predict that the global burden of cardiovascular disease will grow exponentially over the next few years because of the increased prevalence of diabetes and due to the long-term effects of the current COVID-19 pandemic ( 2 , 3 ).…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Peptides to Treat Myocardial Ischemia-Reperfusion Injury

Rico

Konate

Josse

et al. 2022

Front. Cardiovasc. Med.

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Cardiovascular diseases (CVD) including acute myocardial infarction (AMI) rank first in worldwide mortality and according to the World Health Organization (WHO), they will stay at this rank until 2030. Prompt revascularization of the occluded artery to reperfuse the myocardium is the only recommended treatment (by angioplasty or thrombolysis) to decrease infarct size (IS). However, despite beneficial effects on ischemic lesions, reperfusion leads to ischemia-reperfusion (IR) injury related mainly to apoptosis. Improvement of revascularization techniques and patient care has decreased myocardial infarction (MI) mortality however heart failure (HF) morbidity is increasing, contributing to the cost-intense worldwide HF epidemic. Currently, there is no treatment for reperfusion injury despite promising results in animal models. There is now an obvious need to develop new cardioprotective strategies to decrease morbidity/mortality of CVD, which is increasing due to the aging of the population and the rising prevalence rates of diabetes and obesity. In this review, we will summarize the different therapeutic peptides developed or used focused on the treatment of myocardial IR injury (MIRI). Therapeutic peptides will be presented depending on their interacting mechanisms (apoptosis, necroptosis, and inflammation) reported as playing an important role in reperfusion injury following myocardial ischemia. The search and development of therapeutic peptides have become very active, with increasing numbers of candidates entering clinical trials. Their optimization and their potential application in the treatment of patients with AMI will be discussed.

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Global burden of acute myocardial injury associated with COVID-19: A systematic review, meta-analysis, and meta-regression

Cited by 23 publications

References 91 publications

Incidence of acute myocardial injury and its association with left and right ventricular systolic dysfunction in critically ill COVID-19 patients

Incidence of acute myocardial injury and its association with left and right ventricular systolic dysfunction in critically ill COVID-19 patients

A Real Pandora’s Box in Pandemic Times: A Narrative Review on the Acute Cardiac Injury Due to COVID-19

Therapeutic Peptides to Treat Myocardial Ischemia-Reperfusion Injury

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