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Acute Cardiac Injury in COVID-19: A Systematic Review and Meta-analysis
Mehrbod Vakhshoori1, Maryam Heidarpour2, Davood Shafie1
1Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
Acute cardiac injury is a frequent complication in COVID-19 patients, impacting 15% of cases. Severe illness and death are linked to higher rates of myocardial injury, indicating the importance of cardiac biomarkers.
Area of Science:
- Cardiology
- Infectious Diseases
- Biomarkers
Background:
- Coronavirus disease 2019 (COVID-19) primarily affects the respiratory system.
- Cardiac manifestations of COVID-19 are less understood.
- Acute cardiac injury is a potential complication.
Purpose of the Study:
- To analyze COVID-19 data regarding acute cardiac injury.
- To investigate the role of troponin and brain natriuretic peptide (BNP) levels in COVID-19 patients.
Main Methods:
- Systematic review of Medline/PubMed, Scopus, and Google Scholar until March 25, 2020.
- Collected data on acute cardiac injury, troponin, and BNP levels.
- Analyzed data based on clinical status: severe, non-severe, and death.
Main Results:
- Included 11 records with 1394 individuals.
- Incidence of acute cardiac injury was 15%.
- Higher myocardial injury rates in severe/deceased patients (44%) compared to non-severe (5%).
- Elevated troponin levels in 13% of patients; mean troponin 10.23 pg/mL.
- Mean BNP was 216.74 pg/mL.
Conclusions:
- Acute cardiac injury is more common in COVID-19 than initially thought.
- Cardiac biomarkers may aid in diagnosis and prognosis.
- Further research is needed on long-term cardiac complications and biomarker utility.
Background:
Coronavirus disease 2019 (COVID-19) has been widespread since late December 2019, with several symptoms related to the upper and lower respiratory system. However, its cardiac manifestations are less frequently studied. We aimed to analyze the available COVID-19 data on acute cardiac injury, using troponin and brain natriuretic peptide (BNP) levels.
Methods:
We performed a systematic review on Medline/PubMed, Scopus, and Google Scholar databases until March 25, 2020. Relevant records reporting the incidence of acute cardiac injury as well as troponin and BNP levels were collected from published peer-reviewed articles with further analysis according to the clinical status of the patients (severe, non-severe, and death).
Results:
Eleven records of 1394 individuals were included. The mean age of patients with acute cardiac injury was 56.6 ± 33.4 years (males: 54.3%). The incidence of acute cardiac injury was 15% (95% CI: 11, 20%). Further analysis revealed that dead or severe patients had significantly higher percentages of myocardial injury, compared to non-severe ones (peer-reviewed: 44%, 95% CI: 16, 74% vs. 24%, 95% CI: 15, 34% vs. 5%, 95% CI: 1, 12%, respectively). Mean total troponin was 10.23 pg/mL (95% CI: 5.98, 14.47), while 13% (95% CI: 8%, 18%) of patients had elevated levels. Mean BNP was 216.74 pg/mL (95% CI: 3.27, 430.20).
Conclusion:
Acute cardiac injury in COVID-19 patients is more frequent than what was expected at the beginning of the outbreak. Meanwhile, further studies are needed to investigate the utility of cardiac biomarkers as diagnostic and prognostic tools for long-term cardiac complications of this infection.
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