Risk factors for myocardial injury in patients with coronavirus disease 2019 in China

Fan, Qin; Zhu, Hongling; Zhao, Jiaxin; Zhuang, Lingfang; Zhang, Hang; Xie, Hongyang; Zhang, Ruiyan; Granada, Juan F.; Xiang, Xiaogang; Hu, Weiguo; Yan, Xiaoxiang

doi:10.1002/ehf2.13022

Cited by 24 publications

(21 citation statements)

References 31 publications

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“…What's more, our study also identified that elevated LDH, the presence of echocardiographic abnormalities, the presence of cardiac abnormalities at admission, and the severity of COVID-19 were risk factors for cardiac sequelae in COVID-19 survivors in the late convalescent stage. This was consistent with previous study that focused on risk stratification of cardiac involvement in COVID-19 patients during hospitalization [10] . This implies that physicians should pay more attention to these high risk patients during follow-up, and CMR could be performed to screen out cardiovascular involvement in late convalescence.…”

supporting

confidence: 93%

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Risk stratification of cardiac sequelae detected using cardiac magnetic resonance in late convalescence at the six-month follow-up of recovered COVID-19 patients

Zhang

Zheng

et al. 2021

Journal of Infection

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Risk stratification of cardiac sequelae detected using cardiac magnetic resonance in late convalescence at the six-month follow-up of recovered COVID-19 patients Dear editor , Follow-up studies in COVID-19 survivors have found persistent symptoms (fatigue, dyspnea, muscle pain et, al.), impaired pulmonary function, abnormal chest CT images in COVID-19 survivors even after 110 days and 6 month of follow-up. 1 , 2 Several studies also have reported that cardiac involvement, including myocardial edema, fibrosis, and cardiac dysfunction, detected by using multi-parameter cardiac magnetic resonance (CMR) techniques were identified in recovered COVID-19 patients during early convalescence. [3][4][5][6][7][8] However, whether COVID-19 has a continuous influence on the cardiovascular system in late convalescence is unknown. Therefore, we used traditional CMR sequences to evaluate cardiac abnormalities in late convalescence comprehensively, including cardiac function, myocardial deformation, and myocardial tissue characteristics, and explore its related risk factors.34 recovered COVID-19 patients at Chengdu Public Health Clinical Medical Centre were prospectively enrolled and followed-up from Jan 1 to Oct 20, 2020. Diagnosis and discharging of COVID-19 patients were based on guidelines of the Chinese Center for Disease Control and Prevention. 9 Six months after discharging from hospital, gadolinium enhanced CMR scan (1.5T, Signa HDxt; GE Medical systems, USA) was performed and 20 healthy controls were enrolled too. All the patients and healthy controls signed informed consent and the institutional ethics board of our institutes approved this study (No. 2020.43). Electrocardiography, echocardiography, laboratory test, and clinical characters at admission were collected. Cardiac abnormalities were defined as a combination of elevated myocardial enzyme and injury marker, abnormal echocardiographic and electrocardiographic results. Patients was divided into two subgroups, subgroup with/without cardiac abnormalities at admission.Biventricular function, myocardial deformation, myocardial edema and fibrosis were evaluated with postprocessing software Cvi42 (Circle Cardiovascular Imaging, Calgary, Canada). Cardiac dysfunction was a combination of left ventricular ejection fraction (LVEF) less than 50%, right ventricular ejection fraction (RVEF) less than 45%, and LV deformation dysfunction. CMR abnormalities was a combination of myocardial edema, fibrosis, and cardiac dysfunction.At admission, 23 (67.65%) patients had cardiac abnormalities, 7 (20.59%) patients had elevated myocardial enzyme, 2 (5.88%) patients had elevated myocardial injury maker, 3 (8.82%) and 20 (58.82%) patients reported abnormal echocardiographic and electrocardiographic results. None of these 34 patients reported cardiovascular-related symptoms or signs during follow-up.

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supporting

confidence: 93%

“…This was consistent with previous study that focused on risk stratification of cardiac involvement in COVID-19 patients during hospitalization. 10 This implies that physicians should pay more attention to these high risk patients during follow-up, and CMR could be performed to screen out cardiovascular involvement in late convalescence.…”

mentioning

confidence: 99%

Risk stratification of cardiac sequelae detected using cardiac magnetic resonance in late convalescence at the six-month follow-up of recovered COVID-19 patients

Zhang

Zheng

et al. 2021

Journal of Infection

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“…In addition, a high prevalence of pre-existing cardiovascular morbidities, including hypertension, and coronary artery diseases, has been detected among patients with severe SARS-CoV-2 ( 1 , 149 , 156 ). In COVID-19 patients, the highest mortality rates were also observed in case of pre-existing cardiovascular disease and elevated cardiac troponin levels ( 137 , 157 ). Furthermore, patients with higher troponin levels had also increased markers of inflammation, including C-reactive protein, interleukin (IL)-6, ferritin, lactate dehydrogenase (LDH), high neutrophil count, and high amino-terminal pro-B–type natriuretic peptide ( 158 ).…”

Section: Sars-cov-2 Clinical Implication and Potential Mutual Interacmentioning

confidence: 99%

Body Localization of ACE-2: On the Trail of the Keyhole of SARS-CoV-2

et al. 2020

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The explosion of the new coronavirus (SARS-CoV-2) pandemic has brought the role of the angiotensin converting enzyme 2 (ACE2) back into the scientific limelight. Since SARS-CoV-2 must bind the ACE2 for entering the host cells in humans, its expression and body localization are critical to track the potential target organ of this infection and to outline disease progression and clinical outcomes. Here, we mapped the physiological body distribution, expression, and activities of ACE2 and discussed its potential correlations and mutal interactions with the disparate symptoms present in SARS-CoV-2 patients at the level of different organs. We highlighted that despite during SARS-CoV-2 infection ACE2-expressing organs may become direct targets, leading to severe pathological manifestations, and subsequent multiple organ failures, the exact mechanism and the potential interactions through which ACE2 acts in these organs is still heavily debated. Further scientific efforts, also considering a personalized approach aimed to consider specific patient differences in the mutual interactions ACE2-SARS-CoV-2 and the long-term health effects associated with COVID-19 are currently mandatory.

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“…Since the first Chinese reports, a high incidence of cardiac injury, defined as the presence of elevated troponin (Tn) levels above the 99th percentile of the reference interval, was found in COVID-19 patients. The prevalence of cardiac injury ranges from 12% in unselected COVID-19 cases up to 41% in critically ill patients and patients with pre-existing cardiovascular diseases with a further rise to 75.8% in nonsurvivors (Table 3) (14,17,18,24,25,38,39,(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82). The presence of elevated Tn levels is associated with abnormal laboratory findings (including white blood cells count, neutrophil and lymphocyte count, C-reactive protein, procalcitonin, Nterminal pro-B-type natriuretic peptide, D-dimer, transaminases, lactate dehydrogenase, total bilirubin, albumin, prothrombin time, and cytokines) (18) and a higher grade of pulmonary involvement in radiographic findings, suggesting an important multiorgan involvement (21,38,73).…”

Section: Subclinical Acute Myocardial Injury In Covid-19mentioning

confidence: 99%

“…The presence of cardiac injury in COVID-19 is associated with more severe manifestations, complications, and adverse prognosis (14,17,18,24,25,38,39,(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82). Data about the association between cardiac injury and mortality are summarized in Table 3.…”

Section: Sars and Middle East Respiratory Syndrome (Mers) (3)mentioning

confidence: 99%

COVID-19 and Heart Failure: From Epidemiology During the Pandemic to Myocardial Injury, Myocarditis, and Heart Failure Sequelae

Italia

Tomasoni

Bisegna

et al. 2021

Front. Cardiovasc. Med.

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A close and intriguing relationship has been suggested between heart failure (HF) and coronavirus disease 2019 (COVID-19). First, COVID-19 pandemic represented a global public health emergency in the last year and had a catastrophic impact on health systems worldwide. Several studies showed a reduction in HF hospitalizations, ranging from 30 to 66% in different countries and leading to a subsequent increase in HF mortality. Second, pre-existing HF is a risk factor for a more severe clinical course of COVID-19 and an independent predictor of in-hospital mortality. Third, patients hospitalized for COVID-19 may develop both an acute decompensation of chronic HF and de-novo HF as a consequence of myocardial injury and cardiovascular (CV) complications. Myocardial injury occurred in at least 10% of unselected COVID-19 cases and up to 41% in critically ill patients or in those with concomitant CV comorbidities. Few cases of COVID-19-related acute myocarditis, presenting with severe reduction in the left ventricular (LV) ejection fraction and peculiar histopathological findings, were described. However, recent data suggested that COVID-19 may be associated with both systolic and diastolic LV dysfunction, with LV diastolic impairment, pulmonary hypertension, and right ventricular dysfunction representing the most frequent findings in echocardiographic studies. An overview of available data and the potential mechanisms behind myocardial injury, possibly leading to HF, will be presented in this review. Beyond the acute phase, HF as a possible long-term consequence of cardiac involvement in COVID-19 patients has been supposed and need to be investigated yet.

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Risk factors for myocardial injury in patients with coronavirus disease 2019 in China

Cited by 24 publications

References 31 publications

Risk stratification of cardiac sequelae detected using cardiac magnetic resonance in late convalescence at the six-month follow-up of recovered COVID-19 patients

Risk stratification of cardiac sequelae detected using cardiac magnetic resonance in late convalescence at the six-month follow-up of recovered COVID-19 patients

Body Localization of ACE-2: On the Trail of the Keyhole of SARS-CoV-2

COVID-19 and Heart Failure: From Epidemiology During the Pandemic to Myocardial Injury, Myocarditis, and Heart Failure Sequelae

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