Cardiac Injury in COVID-19: A Systematic Review
Malihe Sadat Moayed1, Farshid Rahimi-Bashar2, Amir Vahedian-Azimi3
1Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Insights
COVID-19 infection is linked to a high incidence of cardiac injury, ranging from 7.2-77%. Patients with COVID-19 and myocardial injury face worse outcomes and higher mortality rates.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- The COVID-19 pandemic has caused significant global mortality.
- Understanding the cardiac implications of COVID-19 is crucial for patient management.
Purpose of the Study:
- To systematically review and summarize the incidence and outcomes of cardiac diseases in COVID-19 patients.
- To assess the prevalence of myocardial injury and cardiovascular complications in individuals with confirmed COVID-19 infection.
Main Methods:
- A systematic review of articles published between December 2019 and April 2020.
- Searched electronic databases (Scopus, Web of Science, PubMed, Science Direct, ProQuest) for relevant studies.
- Included observational cohort, case-control, and cross-sectional studies reporting cardiac outcomes in COVID-19 patients.
Main Results:
- Twelve articles met the inclusion criteria, with 8 reporting on cardiac injury incidence (7.2-77%) and cardiovascular outcomes.
- Patients with cardiac injury exhibited worse prognoses, including increased mortality, shock, and malignant arrhythmias.
- Common findings in cardiac injury patients included lung opacities, need for mechanical ventilation, ARDS, AKI, and coagulation disorders.
Conclusions:
- Myocardial injury in COVID-19 patients is associated with a poor prognosis.
- Prompt cardiac investigation and management are essential for improving outcomes in COVID-19 patients with cardiac involvement.
Abstract:
Coronavirus 2019 (COVID-19) is responsible for the current pandemic which has already resulted in considerable mortality worldwide. This systematic review was conducted to summarize the results of the published articles assessing the incidence of heart diseases in patients infected with COVID-19. The electronic databases Scopus, Web of Science, Pubmed, Science Direct, and ProQuest were used to search for potentially relevant articles. Articles published from Dec 2019 to April 2020 were included. All cross-sectional, retrospective or prospective observational cohort and case-control studies were selected which reported the incidence or prevalence of myocardial injury, myocardial infarction, or cardiovascular disease in patients with confirmed COVID-19 infection. Based on the inclusion criteria, 12 articles were selected. The incidence of cardiac injury was reported in 8 articles and 8 articles focused on the cardiovascular outcomes of COVID-19 infection. The incidence of new cardiac injury was reported to be 7.2-77% in live and dead patients, respectively. The results showed that patients with cardiac injury had worse outcomes including higher mortality than those without cardiac injury. The most common cardiac injury outcomes were shock and malignant arrhythmias. The most common radiographic findings in patients with cardiac injury were multiple mottling and ground-glass opacities in the lungs (64.6%). A significant number of patients with cardiac injury required noninvasive mechanical ventilation (46.3%) or invasive mechanical ventilation (22.0%). Acute respiratory distress syndrome was seen in 58.5%, acute kidney injury in 8.5%, electrolyte disturbances in 15.9%, hypoproteinemia in 13.4%, and coagulation disorders in 7.3% of patients with cardiac injuries. In addition, survival days were negatively correlated with cardiac troponin I levels (r = -0.42, 95%, p = 0.005). The results of this review showed that myocardial injury in patients with COVID 19 has a poor prognosis. Hence, cardiac investigation and management in these patients are crucial.
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