Reduced cardiac function is associated with cardiac injury and mortality risk in hospitalized COVID‐19 Patients

Abstract

Background Cardiac injury is common in COVID‐19 patients and is associated with increased mortality. However, it remains unclear if reduced cardiac function is associated with cardiac injury, and additionally if mortality risk is increased among those with reduced cardiac function in COVID‐19 patients. Hypothesis The aim of this study was to assess cardiac function among COVID‐19 patients with and without biomarkers of cardiac injury and to determine the mortality risk associated with reduced cardiac function. Methods/Results This retrospective cohort study analyzed 143 consecutive COVID‐19 patients who had an echocardiogram during hospitalization between March 1, 2020 and May 5, 2020. The mean age was 67 ± 16 years. Cardiac troponin‐I was available in 131 patients and an increased value (>0.03 ng/dL) was found in 59 patients (45%). Reduced cardiac function, which included reduced left or right ventricular systolic function, was found in 40 patients (28%). Reduced cardiac function was found in 18% of patients without troponin‐I elevation, 42% with mild troponin increase (0.04‐5.00 ng/dL) and 67% with significant troponin increase (>5 ng/dL). Reduced cardiac function was also present in more than half of the patients on mechanical ventilation or those deceased. The in‐hospital mortality of this cohort was 28% (N = 40). Using logistic regression analysis, we found that reduced cardiac function was associated with increased mortality with adjusted odds ratio (95% confidence interval) of 2.65 (1.18 to 5.96). Conclusions Reduced cardiac function is highly prevalent among hospitalized COVID‐19 patients with biomarkers of myocardial injury and is independently associated with mortality.

COVID-19-related echocardiographic patterns of cardiovascular dysfunction in critically ill patients: A systematic review of the current literature

“…Overall, the studies included a median of 52.0% (0.0–100.0) of patients admitted to ICU, undergoing forms of invasive or non-invasive mechanical ventilation in 57.0% (34.0–81.0) and 13.0% (8.6–32.7) of cases, respectively. Ten studies (32.2%) were retrospective [ 17 , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] ], and 20 (66.6%) monocentric [ 15 , 17 , 18 , [20] , [21] , [22] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] ].…”

“… Authors Patients (n) Age (years) Male (%) B.M.I. Time to echo (days) HTN (%) DM (%) Obesity (%) CAD (%) Stroke (%) CKD (%) COPD (%) IMV (%) NIV (%) ICU (%) Garcia-Cruz et al [ 42 ] 82 56 (50–66) 62.2 – 0 (0) 47.6 43.9 – – – – – 79 21 100 Van den Heuvel et al [ 35 ] 51 63 (51–68) 80 27 (25–29) – 41 18 – 10 4 2 12 33 – 37 Rath et al [ 32 ] 123 68 (15) 62.2 28 (5) – 69.9 24.4 19.5 22.8 – 11.4 – 40 – 45.5 Chen et al [ 25 ] 143 67 (16) 62 29 (6.3) – 69 38 – 30 10 19 – 35 – – Schott et al [ 45 ] 66 60 (16) 57.6 43 (12) 3 (4,5) 57.6 34.8 – 15.2 – 4.5 12.1 ...…”

“…RV function assessment has been performed using quantitative/semi-quantitative [ 28 , 32 , 41 ] ( i.e. , adopting either the TAPSE or RV fractional area change) or a qualitative operator-dependent evaluation [ 25 , 45 ]. Both Lassen et al and Baycan et al showed a significant difference in RV longitudinal strain and GLS.…”

Prevalence of Atrial Fibrillation and Associated Mortality Among Hospitalized Patients With COVID-19: A Systematic Review and Meta-Analysis

“…More recently, numerous epidemiological studies have shown an increased risk of AF and new-onset AF among patients with COVID-19 but have yielded inconsistent results (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). Moreover, accumulating literature has demonstrated that AF or new-onset AF might be significantly associated with the worst outcomes (e.g., mortality) in patients with COVID-19 (21,25,29).…”

Mapping the SARS-CoV-2–Host Protein–Protein Interactome by Affinity Purification Mass Spectrometry and Proximity-Dependent Biotin Labeling: A Rational and Straightforward Route to Discover Host-Directed Anti-SARS-CoV-2 Therapeutics

“…Moreover, a recent study revealed that cavin-1 deficiency affects a number of coronary and myocardial functions, including ischaemic tolerance and stretch responses [ 99 ]. Interestingly, cardiac injury has been reported in COVID-19 patients [ 100 ], even in the absence of coronary arteries obstruction [ 101 ], therefore unlikely to be caused by altered coagulation observed in these patients [ 102 ]. Furthermore, a mechanism of entry of SARS-CoV-2 in cardiomyocytes has been recently proposed [ 103 ].…”