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Published on: December 19, 2020
[Cardiac presentations in severe and critical coronavirus disease 2019]
Yuwei Tong1, Zhiwei Xie2, Yueping Li2
1Department of Internal Medicine, the Eighth People's Hospital of Guangzhou, Guangzhou 510000, Guangdong, China.
Insights
Severe and critical COVID-19 patients often show elevated myocardial injury markers and abnormal electrocardiograms (ECG). Dynamic changes in these markers and ECG can indicate the extent of cardiac damage in patients with COVID-19.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease 2019 (COVID-19) can lead to severe and critical illness.
- Cardiac complications are a significant concern in severe COVID-19 cases.
Purpose of the Study:
- To investigate cardiac presentations in severe and critical COVID-19 patients.
- To identify potential influencing factors related to cardiac involvement.
Main Methods:
- Retrospective study of 55 severe and critical COVID-19 patients.
- Comparison of myocardial injury markers (LDH, AST, CK, cTnI, MYO, CK-MB, BNP) and ECG changes between severe and critical groups.
Main Results:
- Elevated myocardial injury markers and abnormal ECGs were common in severe and critical COVID-19.
- Lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) were frequently elevated.
- Significant difference in elevated creatine kinase (CK) between severe and critical groups (P=0.027).
- Nonspecific T wave changes were the most common ECG abnormality.
Conclusions:
- Elevated myocardial injury markers and abnormal ECGs are not specific indicators of myocardial injury in COVID-19.
- Dynamic monitoring of myocardial injury markers and ECG can reflect the severity of cardiac damage.
Objective:
To investigate the cardiac presentations and the possible influencing factors of severe and critical coronavirus disease 2019 (COVID-19).
Methods:
A retrospective study was conducted. Patients with severe and critical COVID-19 admitted to the Eighth People's Hospital of Guangzhou from January 21st to February 24th 2020 were enrolled. According to the clinical classification, the patients were divided into severe group and critical group. The myocardial injury markers, such as lactate dehydrogenase (LDH), aspartate aminotransferase (AST), creatine kinase (CK), cardiac troponin I (cTnI), myoglobin (MYO), MB isoenzyme of creatine kinase (CK-MB), B-type natriuretic peptide (BNP) and electrocardiogram (ECG) changes were compared between the two groups.
Results:
A total of 55 COVID-19 patients were selected, including 15 critical cases and 40 severe cases. The patients with severe and critical COVID-19 were male-dominated (61.8%), the average age was (61.2±13.0) years old, 83.6% (46 cases) of them had contact history of Hubei, 38.2% (21 cases) of them were complicated with hypertension. There was no significant difference in baseline data between the critical group and the severe group. Myocardial injury markers of critical and severe COVID-19 patients were increased in different proportion, LDH increased in most patients (20 severe cases and 7 critical cases), followed by AST (16 severe cases and 5 critical cases). There was significant difference in the number of patients with elevated CK between severe group and critical group (cases: 1 vs. 4, P = 0.027). Abnormal ECG was found in 39 of 42 patients with ECG examination. Nonspecific change of T wave was the most common. Before and after treatment, 9 of 15 patients with changes of ECG and myocardial injury markers had oxygenation index less than 100 mmHg (1 mmHg = 0.133 kPa), and the prominent changes of ECG were heart rate increasing and ST-T change.
Conclusions:
The increase of myocardial injury markers and abnormal ECG were not specific to the myocardial injury of severe and critical COVID-19 patients. At the same time, the dynamic changes of myocardial injury markers and ECG could reflect the situation of myocardial damage.
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