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Predicting Acute Cardiovascular Complications in COVID-19: Insights from a Specialized Cardiac Referral Department

Michał Machowski1, Aisha Ou-Pokrzewińska1, Katarzyna Perzanowska-Brzeszkiewicz1

  • 1Department of Internal Medicine and Cardiology with the Center for Management of Venous Thromboembolic Disease, Medical University of Warsaw, Warsaw, Poland.

Medical Science Monitor : International Medical Journal of Experimental and Clinical Research
|April 22, 2024
PubMed

Insights

COVID-19 patients face increased risks of cardiovascular diseases (CVDs). Acute coronary syndrome (ACS) significantly raises mortality, while acute pulmonary embolism (APE) and acute myocarditis (AMyo) do not independently impact death risk in COVID-19 patients.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Pulmonology

Background:

  • COVID-19 is associated with an elevated risk of acute cardiovascular diseases (CVDs), including acute coronary syndrome (ACS), acute pulmonary embolism (APE), and acute myocarditis (AMyo).
  • The precise influence of these CVDs on COVID-19 patient mortality remains incompletely understood.
  • This study investigates the impact of CVDs on COVID-19 pneumonia progression and their detectability using standard clinical tools.

Purpose of the Study:

  • To determine if CVDs affect the clinical course of COVID-19 pneumonia.
  • To assess the utility of common diagnostic tests and examinations in identifying CVDs in COVID-19 patients.
  • To analyze the independent impact of ACS, APE, and AMyo on in-hospital mortality among COVID-19 patients.

Main Methods:

  • Analysis of data from 249 consecutive COVID-19 patients admitted to a cardiology department.
  • Inclusion of clinical status, biomarker levels, computed tomography (CT) scans, and bedside echocardiography upon admission.
  • Statistical analysis to evaluate predictive values of biomarkers and the influence of CVDs on mortality, adjusting for lung involvement.

Main Results:

  • D-dimer levels effectively predicted APE (AUC=0.850), with a sensitivity of 69.4% and specificity of 96.2% at a threshold of 4968.0 ng/mL.
  • NT-proBNP levels predicted AMyo (AUC=0.692), showing 54.5% sensitivity and 86.5% specificity at a cut-off of 8970 pg/mL.
  • Troponin T levels were not diagnostically useful for differentiating CVDs. Lung involvement extent predicted mortality (OR=1.03). ACS independently increased mortality (OR=5.27), whereas APE and AMyo did not significantly affect death risk after adjusting for lung disease.

Conclusions:

  • D-dimer and NT-proBNP are valuable biomarkers for differentiating CVDs in COVID-19 patients, unlike troponin T.
  • Acute coronary syndrome in conjunction with COVID-19 significantly elevates in-hospital mortality, independent of lung disease severity.
  • Acute pulmonary embolism and acute myocarditis, when co-occurring with COVID-19, did not demonstrate an independent impact on in-hospital mortality in this cohort.

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