Prevalence and clinical outcomes of cardiac injury in patients with COVID-19: A systematic review and meta-analysis

Huang, Zhen; Huang, Pan; Du, Binbin; Kong, Lingyao; Zhang, Wenyuan; Zhang, Yanzhou; Dong, Jianzeng

doi:10.1016/j.numecd.2020.09.004

Cited by 17 publications

(21 citation statements)

References 65 publications

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“…Among cardiac complications, the pooled incidences of AMI, shock, and HF were reported in the severe and deceased COVID-19 patients. Among patients with severe disease, the summarized incidences of AMI 29 , 52 , and shock 22 , 31 were computed as 29.67% (95% CI = 17.95-41.41) and 35.2 (95% CI = 22.21-47.84), respectively. We did not estimate the summarized pooled incidence of HF, because it was reported only in one study 44 (47.8%, 95% CI = 41.4-54.2) 44 .…”

Section: Resultsmentioning

confidence: 99%

“…We did not estimate the summarized pooled incidence of HF, because it was reported only in one study 44 (47.8%, 95% CI = 41.4-54.2) 44 . Additionally, the summarized pooled incidences of AMI 29 , 44 , 46 , 52 and arrhythmia 44 , 49 in the deceased COVID-19 patients were 61% (95% CI = 57.89-64.11) and 47.56 (95% CI = 38.33-56.78), respectively ( Table 2 ). The forest plots are shown in Supplementary Fig.…”

Section: Resultsmentioning

confidence: 99%

“…The pooled RR of admission to ICU and mortality in COVID-19 patients were reported in two 23 , 52 and three studies 23 , 26 , 52 , respectively. As the summarized pooled RR shows, patients with AMI hospitalized in ICU or were deceased by 3.33-fold (95% CI = 1.97-4.69, p <0.001) and 4.76–fold (95% CI = 3.82-5.69, p < 0.001), respectively, more than patients without it.…”

Section: Resultsmentioning

confidence: 99%

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Incidence of cardiac complications following COVID-19 infection: An umbrella meta-analysis study

et al. 2022

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Background COVID-19 causes fatal cardiac damages. Despite many overwhelming meta-analysis related to cardiac complications following COVID-19 disease, no umbrella meta-analysis study has been conducted. Objectives We aimed to report the summarized pooled incidences of cardiac complications in the overall, critically ill, and deceased patients, compare the cardiac complications between the severe/non-severe or deceased/non-deceased patients, and also compare poor outcomes between patients with/without acute myocardial injury (AMI). Methods PubMed, Scopus, web of science, Cochrane, ProQuest, Springer, Sage journals were searched before April 2021. After assessing the quality and duplicate data, data were run by the random/fixed-effect models, I2 heterogeneity index, Egger's test, and sensitivity analysis. Results After removing duplicate data, in the overall COVID-19 patients, the pooled incidence of AMI, heart failure, arrhythmia, cardiac arrest, and acute coronary syndrome (ACS) were 21%, 14%, 16%, 3.46%, and 1.3% respectively. In the patients with severe disease, the pooled incidence of AMI and shock were 33 and 35%, respectively. Similarly, in the deceased COVID-19 patients, the pooled incidence rate of AMI and arrhythmia were 56% and 47.5%, respectively. The patients with severe disease were at higher risk of AMI (RR = 5.27) and shock (OR = 20.18) compared with the non-severe cases. Incidence of AMI was associated with transfer to the intensive care units (ICU) (RR = 2.92) and mortality (RR=2.57, OR = 8.36), significantly. Conclusion Cardiac complications were found to be increased alarmingly in COVID-19 patients. Baseline and during hospitalization checking with electrocardiography, echocardiography, and measuring of cardiac biomarkers should be applied.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Incidence of cardiac complications following COVID-19 infection: An umbrella meta-analysis study

et al. 2022

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“…However, critically ill patients could have elevated cardiac markers from mismatch between myocardial oxygen supply and demand without structural cardiovascular abnormalities. The prevalence of cardiac injury was reported to be 19% in total COVID-19 patients, 36% in severe COVID-19 patients, and 48% in non-survivors 19 . Furthermore, cardiac injury was found to be associated with a significant increase in the risk of poor outcomes, severe disease, admission to ICU, and mortality 18 .…”

Section: Discussionmentioning

confidence: 99%

Outcomes and Risk Factors for Cardiovascular Events in Hospitalized COVID-19 Patients

Samanapally

Nathala

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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Objective To analyze outcomes and risk factors of cardiovascular events in a metropolitan COVID-19 database, and to perform a subgroup analysis in African American populations to determine whether outcomes and risk factors are influenced by race. Design Retrospective cohort analysis from March 9, 2020 to June 20, 2020. Setting Population-based study in Louisville, KY, USA Participants 700 adult inpatients hospitalized with COVID-19. Interventions N/A Measurements and Main Results: Our cohort consisted of 126 patients (18%) with cardiovascular events and 574 patients without cardiovascular events. Patients with cardiovascular events had a much higher mortality rate than those without cardiovascular events (45.2% vs. 8.7%, p <0.001). There was no difference between African Americans and Whites regarding mortality (43.9% vs 46.3%, p =1) and length of stay for survivors (11 days vs. 9.5 days, p =0.301). Multiple logistics regression analysis suggested that male, race, lower SaO2/FiO2, higher serum potassium, lower serum albumin, and number of cardiovascular co-morbidities were highly associated with the occurrence of cardiovascular events in COVID-19 patients. Lower serum albumin and neoplastic/immune compromised diseases were highly associated with cardiovascular events for African American COVID-19 patients. SaO2/FiO2 ratio and cardiovascular comorbidity count were significantly associated with cardiovascular events in white patients. Conclusions : Cardiovascular events were prevalent and associated with worse outcomes in hospitalized patients with COVID-19. Outcomes of cardiovascular events in African American and white COVID-19 patients were similar after propensity score matching analysis. There were common and unique risk factors for cardiovascular events in African American COVID-19 patients when compared with white patients.

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“…Myocardial injury is a common sequela among patients hospitalized with SARS-CoV-2 infection, more frequently reported in intensive care unit patients, 1 and it correlates with worse prognosis and higher mortality. 2 , 3 The pathophysiology of myocardial injury in patients with SARS-CoV-2 infection is not yet precisely defined but is believed to be multifactorial. Possible underlying mechanisms include ischemia due to macro- or micro-thrombotic arterial occlusions, non-ischemic myocarditis, local, and/or systemic inflammation with coagulopathy as well as hypoperfusion secondary to hypotension, hypoxia, and shock.…”

Section: Discussionmentioning

confidence: 99%

Distinct Coagulopathy With Myocardial Injury and Pulmonary Embolism in COVID-19

Fath

Aglan

Varkoly

et al. 2021

Journal of Investigative Medicine High Impact Case Reports

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In this article, we report a case of a 61-year-old male who was diagnosed with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), presenting with acute respiratory distress syndrome requiring intubation and hemodynamic support, marked D-Dimer and troponin I elevation, worsening ST-elevation myocardial infarction on repeat electrocardiograms, and a negative coronary angiogram ruling out a coronary artery thrombosis or occlusion. With worsening diffuse ST-segment elevation on electrocardiograms and reduced ejection fraction on echocardiography in the setting of systemic inflammation, fulminant myocarditis was highly suspected. Despite optimal medical treatment, the patient’s condition deteriorated and was complicated by cardiac arrest that failed resuscitation. Although myocarditis was initially suspected, the autopsy revealed no evidence of myocarditis or pericarditis but did demonstrate multiple microscopic sites of myocardial ischemia together with thrombi in the left atrium and pulmonary vasculature. Additionally, scattered microscopic cardiomyocyte necrosis with pathological diagnosis of small vessel micro-thrombotic occlusions. These findings are potentially exacerbated by inflammation-induced coagulopathy, hypoxia, hypotension, and stress, that is, a multifactorial etiology. Further research and an improved understanding are needed to define the precise pathophysiology of the coagulopathic state causing widespread micro-thrombosis with subsequent myocardial and pulmonary injury.

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Prevalence and clinical outcomes of cardiac injury in patients with COVID-19: A systematic review and meta-analysis

Cited by 17 publications

References 65 publications

Incidence of cardiac complications following COVID-19 infection: An umbrella meta-analysis study

Incidence of cardiac complications following COVID-19 infection: An umbrella meta-analysis study

Outcomes and Risk Factors for Cardiovascular Events in Hospitalized COVID-19 Patients

Distinct Coagulopathy With Myocardial Injury and Pulmonary Embolism in COVID-19

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