Suspected myocardial injury in patients with COVID-19: Evidence from front-line clinical observation in Wuhan, China

Abstract

Background: A novel coronavirus disease in Wuhan has caused an outbreak and become a major public health issue in China and great concern from international community. Myocarditis and myocardial injury were suspected and may even be considered as one of the leading causes for death of COVID-19 patients. Therefore, we focused on the condition of the heart, and sought to provide firsthand evidence for whether myocarditis and myocardial injury were caused by COVID-19. Methods: We enrolled patients with confirmed diagnosis of COVID-19 retrospectively and collected heart-related clinical data, mainly including cardiac imaging findings, laboratory results and clinical outcomes. Serial tests of cardiac markers were traced for the analysis of potential myocardial injury/myocarditis. Results: 112 COVID-19 patients were enrolled in our study. There was evidence of myocardial injury in COVID-19 patients and 14 (12.5%) patients had presented abnormalities similar to myocarditis. Most of patients had normal levels of troponin at admission, that in 42 (37.5%) patients increased during hospitalization, especially in those that died. Troponin levels were significantly increased in the week preceding the death. 15 (13.4%) patients have presented signs of pulmonary hypertension. Typical signs of myocarditis were absent on echocardiography and electrocardiogram. Conclusions: The clinical evidence in our study suggested that myocardial injury is more likely related to systemic consequences rather than direct damage by the 2019 novel coronavirus. The elevation in cardiac markers was probably due to secondary and systemic consequences and can be considered as the warning sign for recent adverse clinical outcomes of the patients.

Observations on echocardiographic findings in patients with COVID-19

“…Ours is one of the rst studies to assess echocardiographic ndings in admitted COVID-19 patients, irrespective of severity and its relationship to several biomarkers. Previous studies have detailed cardiac injury associated with COVID-19 based on troponin levels, ECG ndings and echocardiogram features (13)(14)(15). The aetiology of cardiac dysfunction as it relates to abnormal TTE is likely to be multifactorial as shown in our study with no relation between troponin and abnormal TTE.…”

“…Some have stipulated various consequences and molecular mechanisms, nothing of which is substantial or causal (5,12). Although many studies have examined the potential of troponin I as a marker of severity, there are very few studies, to our knowledge, that have examined the echocardiography ndings in COVID-19 patients (13)(14)(15). Complicating this is the di culty of performing echocardiography at bedside whilst using personal protective equipment and the risk of infection to staff from enhanced exposure to this virus.…”

Prognostic value of Cardiac Biomarkers in COVID-19 Infection: A Meta-analysis

“…Five studies reported biomarkers based on whether the patients survived or died, 20,[22][23][24][25] ve studies reported them based on whether the patient was critically ill or not. [11][12][13][14]26 Of the latter studies, 4 categorized patients as sick based on the need for ICU admission, and 1 study based it on evidence of ARDS. 21 Baseline demographics and comorbidities of patients included in the studies are shown in Table 2.…”

Incidence and consequences of systemic arterial thrombotic events in COVID-19 patients

“…There is convincing analytical and clinical data on the cardiac [4][5][6][7] and cerebral [8] involvement in patients with COVID-19. Although the incidence of thrombotic events, at least for cerebrovascular, seems to be higher than expected and their consequences are certainly very serious, the overall incidence of systemic arterial events is low, 1%.…”

“…In patients with SARS-CoV2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection it has been recently emphasized that thrombotic events contribute to the severity [1] of the disease and antithrombotic treatment has been gradually scaled up worldwide [2]. An increased incidence of pulmonary embolism has been reported [3] and there is also evidence of cardiac involvement with elevated markers of myocardial damage in 10-20% of cases [4,5]. Small series of patients with coronary [6,7], cerebrovascular [8] and peripheral arterial events [9] have been reported, but their true incidence and clinical consequences are not well established.…”