Prevalence and prognostic associations of cardiac abnormalities among hospitalized patients with COVID-19: a systematic review and meta-analysis

Abstract

Although most patients recover from COVID-19, it has been linked to cardiac, pulmonary, and neurologic complications. Despite not having formal criteria for its diagnosis, COVID-19 associated cardiomyopathy has been observed in several studies through biomarkers and imaging. This study aims to estimate the proportion of COVID-19 patients with cardiac abnormalities and to determine the association between the cardiac abnormalities in COVID-19 patients and disease severity and mortality. Observational studies published from December 1, 2019 to September 30, 2020 were obtained from electronic databases (PubMed, Embase, Cochrane Library, CNKI) and preprint servers (medRxiv, bioRxiv, ChinaXiv). Studies that have data on prevalence were included in the calculation of the pooled prevalence, while studies with comparison group were included in the calculation of the odds ratio. If multiple tests were done in the same study yielding different prevalence values, the largest one was used as the measure of prevalence of that particular study. Metafor using R software package version 4.0.2 was used for the meta-analysis. A total of 400 records were retrieved from database search, with 24 articles included in the final analysis. Pooled prevalence of cardiac abnormalities in 20 studies was calculated to be 0.31 [95% Confidence Intervals (CI) of (0.23; 0.41)], with statistically significant heterogeneity (percentage of variation or I-squared statistic I2 = 97%, p < 0.01). Pooled analysis of 19 studies showed an overall odds ratio (OR) of 6.87 [95%-CI (3.92; 12.05)] for cardiac abnormalities associated with disease severity and mortality, with statistically significant heterogeneity (I2 = 85%, between-study variance or tau-squared statistic τ2 = 1.1485, p < 0.01). Due to the high uncertainty in the pooled prevalence of cardiac abnormalities and the unquantifiable magnitude of risk (although an increased risk is certain) for severity or mortality among COVID-19 patients, much more long-term prognostic studies are needed to check for the long-term complications of COVID-19 and formalize definitive criteria of “COVID-19 associated cardiomyopathy”.

Cardiac biomarkers and COVID-19: A systematic review and meta-analysis

“…Our meta-analysis of 16,791 samples suggests that increased cardiac biomarkers at admission in patients with COVID-19 infection are related to increased risk of disease and death. The present study’s findings of increase in mortality and severity risk among COVID-19 patients with cardiac abnormality biomarkers test are consistent with previous narrative reviews [ 9 , [74] , [75] , [76] ].…”

Impact of SARS‐Cov‐2 infection in patients with hypertrophic cardiomyopathy: results of an international multicentre registry

“…Overall, the present findings are in keeping with recent reports that patients with cardiovascular comorbidities are more likely to develop an adverse course due to SARS-Cov-2 infection [8][9][10][11][12] and support aggressive and systematic implementation of SARS-Cov-2 prophylaxis and management options in HCM patients, particularly in the presence of high-risk features.…”

The Impact of Cardiovascular Risk Factors and Renal Disease on Outcomes in Patients Hospitalized with COVID-19: An Observational Study from Two Public Hospitals in Brazil

“…Several systematic reviews found the predictors of severity and lethality in COVID-19 non-Brazilian patients. [6][7][8][10][11][12] Our findings in a Brazilian population are in accordance with such studies. In a systematic review by Harrison et al, CKD was the strongest predictor of higher lethality and severe disease (OR 3.07, 95%CI 2.43-3.88), followed by diabetes mellitus (OR 2.09, 95%CI 1.8-2.42) and hypertension (OR 2.5, 95%CI 2.02-3.11).…”

“…4,5 The cardiovascular impact of COVID-19 in patients has recently been confirmed in several large studies from different parts of the world. [6][7][8][9][10][11][12] Furthermore, patients with COVID-19 may…”