Myocardial injury in hospitalized COVID-19 patients: a retrospective study, systematic review, and meta-analysis

Changal, Khalid; Veria, Spiro; Mack, Sean; Paternite, David; Sheikh, Shoaib Altaf; Patel, Mitra; Mir, Tanveer; Sheikh, Mujeeb; Ramanathan, P. Kasi

doi:10.1186/s12872-021-02450-3

Cited by 18 publications

(22 citation statements)

References 25 publications

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“…In a systematic review and meta‐analysis, Changal et al 10 showed that hospitalized COVID‐19 patients have a high prevalence of myocardial injury, which was associated with a high risk of mortality. The studies included in this meta‐analysis were primarily conducted during the active phase of COVID‐19.…”

Section: Introductionmentioning

confidence: 99%

“…7 In addition to potential injury associated with the illness, some medications used to treat patients with COVID-19 8 and drug interactions may also have potential side effects specific to the heart. 9 In a systematic review and meta-analysis, Changal et al 10 showed that hospitalized COVID-19 patients have a high prevalence of myocardial injury, which was associated with a high risk of mortality. The studies included in this meta-analysis were primarily conducted during the active phase of COVID-19.…”

Section: Introductionmentioning

confidence: 99%

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The effect of SARS‐CoV‐2 infection on cardiac function in post‐COVID‐19 survivors: A systematic review and meta‐analysis

Rahmati

Koyanagi

Banitalebi

et al. 2022

Journal of Medical Virology

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The longitudinal trajectories of cardiac structure and function following SARS‐CoV‐2 infection are unclear. Therefore, this meta‐analysis aims to elucidate the effect of SARS‐CoV‐2 infection on cardiac function in coronavirus disease 2019 (COVID‐19) survivors after recovery. PubMed/MEDLINE, CENTRAL, and EMBASE were systematically searched for articles published up to 1st August 2022. A systematic review and meta‐analysis were performed to calculate the pooled effects size and 95% confidence interval of each outcome. A total of 21 studies including 2394 individuals (1436 post‐COVID‐19 cases and 958 controls) were included in the present meta‐analysis. The pooled analyses compared with control groups showed a significant association between post‐COVID‐19 and reduced left ventricular ejection fraction (LV EF), LV end‐diastolic volume (LV EDV), LV stroke volume (LV SV), mitral annular plane systolic excursion (MAPSE), global longitudinal strain, right ventricular EF (RV EF), RV EDV, RV ESV, RV SV, tricuspid annular plane systolic excursion, and increased LV mass. Subgroup analysis based on the severity of COVID‐19 in the acute phase and subsequent chronic outcomes revealed that LV EF, MAPSE, RV EF, and RV ESV only decreased in studies including patients with a history of intensive care unit admission. Cardiac impairment after SARS‐CoV‐2 infection persisted in recovered COVID‐19 patients even after 1 year. Future studies are warranted to determine the biological mechanisms underlying the long‐term cardiovascular consequences of COVID‐19.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The effect of SARS‐CoV‐2 infection on cardiac function in post‐COVID‐19 survivors: A systematic review and meta‐analysis

Rahmati

Koyanagi

Banitalebi

et al. 2022

Journal of Medical Virology

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“…Myocardial injury appears to be linked to severity of COVID-19 disease and mortality [ 4 – 10 ]. Mortality from COVID-19 is reported to be higher among hospitalized patients with myocardial injury, compared to those without, [ 4 , 6 , 7 , 11 , 12 ]. Indicating that myocardial injury may portend a poorer prognosis.…”

Section: Introductionmentioning

confidence: 99%

Incidence of acute myocardial injury and its association with left and right ventricular systolic dysfunction in critically ill COVID-19 patients

Jansson

Blixt

Didriksson

et al. 2022

Ann. Intensive Care

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Background Previous studies have found an increase in cardiac troponins (cTns) and echocardiographic abnormalities in patients with COVID-19 and reported their association with poor clinical outcomes. Whether acute injury occurs during the course of critical care and if it is associated with cardiac function is unknown. The purpose of this study was to document the incidence of acute myocardial injury (AMInj) and echocardiographically defined left ventricular (LV) and right ventricular (RV) systolic dysfunction in consecutive patients admitted to an intensive care unit (ICU) for COVID-19. The relationship between AMInj and echocardiographic abnormalities during the first 14 days of ICU admission was studied. Finally, the association between echocardiographic findings, AMInj and clinical outcome was evaluated. Methods Seventy-four consecutive patients (≥18 years) admitted to the ICU at Linköping University Hospital between 19 Mar 2020 and 31 Dec 2020 for COVID-19 were included. High-sensitivity troponin-T (hsTnT) was measured daily for up to 14 days. Transthoracic echocardiography was conducted within 72 h of ICU admission. Acute myocardial injury was defined as an increased hsTnT > 14ng/l and a > 20% absolute change with or without ischaemic symptoms. LV and RV systolic dysfunction was defined as at least 2 abnormal indicators of systolic function specified by consensus guidelines. Results Increased hsTnT was observed in 59% of patients at ICU admission, and 82% developed AMInj with peak levels at 8 (3–13) days after ICU admission. AMInj was not statistically significantly associated with 30-day mortality but was associated with an increased duration of invasive mechanical ventilation (10 (3–13) vs. 5 days (0–9), p=0.001) as well as ICU length of stay (LOS) (19.5 (11–28) vs. 7 days (5–13), p=0.015). After adjustment for SAPS-3 and admission SOFA score, the effect of AMInj was significant only for the duration of mechanical ventilation (p=0.030). The incidence of LV and RV dysfunction was 28% and 22%, respectively. Only indices of LV and RV longitudinal contractility (mitral and tricuspid annular plane systolic excursion) were associated with AMInj. Echocardiographic parameters were not associated with clinical outcome. Conclusions Myocardial injury is common in critically ill patients with COVID-19, with AMInj developing in more than 80% after ICU admission. In contrast, LV and RV dysfunction occurred in approximately one-quarter of patients. AMInj was associated with an increased need for mechanical ventilation and ICU LOS but neither AMInj nor ventricular dysfunction was significantly associated with mortality.

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“…The majority of studies (46 studies) reported the impact of CI on mortality (Table 1) [5,12,15,17,18,20,[22][23][24]29,[31][32][33]35,39,40,[42][43][44][45][46][47][48][49][50][51][52][53][56][57][58][59][60][61][62][63][64][65][66][67]70,73,74,[76][77][78].…”

Section: Resultsmentioning

confidence: 99%

“…Among the different statistical indices, OR was the most frequently used (29 studies) [4,5,12,21,22,[24][25][26][27][32][33][34]40,[42][43][44]47,48,50,52,58,59,[62][63][64]70,74,77,78], while RR and HR were used in 10 [15,18,23,39,45,48,56,57,72,73] and 6 studies [51,52,60,65,66,77], respectively. A minority of meta-analyses investigated pooled differences of cardiac biomarkers between severe vs non-severe disease or survivors vs non survivors (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Cardiac Injury in COVID-19: A Systematic Review of Relevant Meta-Analyses

Kyriakoulis¹,

Kyriakoulis²,

Trontzas³

et al. 2022

Rev. Cardiovasc. Med.

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Background: Cardiac injury (CI) is not a rare condition among hospitalized patients with coronavirus disease 2019 . Its prognostic value has been extensively reported through the literature, mainly in the context of observational studies. An impressive number of relevant meta-analyses has been conducted. These meta-analyses present similar and consistent results; yet interesting methodological issues emerge. Methods: A systematic literature search was conducted aiming to identify all relevant meta-analyses on (i) the incidence, and (ii) the prognostic value of CI among hospitalized patients with COVID-19. Results: Among 118 articles initially retrieved, 73 fulfilled the inclusion criteria and were included in the systematic review. Various criteria were used for CI definition mainly based on elevated cardiac biomarkers levels. The most frequently used biomarker was troponin. 30 meta-analyses reported the pooled incidence of CI in hospitalized patients with COVID-19 that varies from 5% to 37%. 32 meta-analyses reported on the association of CI with COVID-19 infection severity, with only 6 of them failing to show a statistically significant association. Finally, 46 meta-analyses investigated the association of CI with mortality and showed that patients with COVID-19 with CI had increased risk for worse prognosis. Four meta-analyses reported pooled adjusted hazard ratios for death in patients with COVID-19 and CI vs those without CI ranging from 1.5 to 3. Conclusions: The impact of CI on the prognosis of hospitalized patients with COVID-19 has gained great interest during the pandemic. Methodological issues such as the inclusion of not peer-reviewed studies, the inclusion of potentially overlapping populations or the inclusion of studies with unadjusted analyses for confounders should be taken into consideration. Despite these limitations, the adverse prognosis of patients with COVID-19 and CI has been consistently demonstrated.

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Myocardial injury in hospitalized COVID-19 patients: a retrospective study, systematic review, and meta-analysis

Cited by 18 publications

References 25 publications

The effect of SARS‐CoV‐2 infection on cardiac function in post‐COVID‐19 survivors: A systematic review and meta‐analysis

The effect of SARS‐CoV‐2 infection on cardiac function in post‐COVID‐19 survivors: A systematic review and meta‐analysis

Incidence of acute myocardial injury and its association with left and right ventricular systolic dysfunction in critically ill COVID-19 patients

Cardiac Injury in COVID-19: A Systematic Review of Relevant Meta-Analyses

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