Impact of congestive heart failure and role of cardiac biomarkers in COVID-19 patients: A systematic review and meta-analysis

Abstract

Background Coronavirus disease 2019 (COVID-19) has been reported to cause worse outcomes in patients with underlying cardiovascular disease, especially in patients with acute cardiac injury, which is determined by elevated levels of high-sensitivity troponin. There is a paucity of data on the impact of congestive heart failure (CHF) on outcomes in COVID-19 patients. Methods We conducted a literature search of PubMed/Medline, EMBASE, and Google Scholar databases from 11/1/2019 till 06/07/2020, and identified all relevant studies reporting cardiovascular comorbidities, cardiac biomarkers, disease severity, and survival. Pooled data from the selected studies was used for metanalysis to identify the impact of risk factors and cardiac biomarker elevation on disease severity and/or mortality. Results We collected pooled data on 5,967 COVID-19 patients from 20 individual studies. We found that both non-survivors and those with severe disease had an increased risk of acute cardiac injury and cardiac arrhythmias, our pooled relative risk (RR) was — 8.52 (95% CI 3.63–19.98) (p<0.001); and 3.61 (95% CI 2.03–6.43) (p=0.001), respectively. Mean difference in the levels of Troponin-I, CK-MB, and NT-proBNP was higher in deceased and severely infected patients. The RR of in-hospital mortality was 2.35 (95% CI 1.18–4.70) (p=0.022) and 1.52 (95% CI 1.12–2.05) (p=0.008) among patients who had pre-existing CHF and hypertension, respectively. Conclusion Cardiac involvement in COVID-19 infection appears to significantly adversely impact patient prognosis and survival. Pre-existence of CHF, and high cardiac biomarkers like NT-pro BNP and CK-MB levels in COVID-19 patients correlates with worse outcomes.

Heart Failure and Coronavirus Disease-19

“…In addition, auxiliary examinations related to heart failure in COVID-19 patients are significantly worse compared to the results in subjects without COVID-19. The level of cardiac biomarkers including N-terminal-proB-type natriuretic peptide, troponin-I, and creatine kinase-myocardial band is higher in deceased and severely infected COVID-19 patient [14], [15], [17]. Troponin level is also positively correlated with the presence of cardiovascular manifestations in patients with COVID-19 [17].…”

“…COVID-19 is a disease caused by SARS-CoV-2 [14], [15], [16]. SARS-CoV-2 shares 96.2% of its property with bat coronavirus.…”

“…Previously, coronaviruses have caused two disease outbreaks, namely, severe acute respiratory syndrome and Middle East respiratory syndrome [16]. The virus invades host's cell through angiotensin converting enzyme-2 (ACE-2) as the receptor [14], [15], [16], [17]. The spike glycoprotein (S protein) of the virus binds with ACE-2 and starts membrane fusion.…”

“…Besides, increased metabolic demand may surpass the fulfillment ability of host's body. All of the conditions impair normal cardiac function and result in heart failure [1], [14], [15], [16], [17]. Heart failure itself can be deteriorated and causes cardiogenic shock.…”

“…Subjects with underlying comorbidities tend to suffer more severe course of COVID-19. Cardiovascular disease is one of the most common accompanying comorbidities in COVID-19 patients [13], [14], [15], [16], [17], [21]. Patients with existing cardiovascular disease have a mortality rate above 10% [15].…”