The impact of 2019 novel coronavirus on heart injury: A Systematic review and Meta-analysis

Abstract

Journal Pre-proof J o u r n a l P r e -p r o o f Abstract Background: Evidence about COVID-19 on cardiac injury is inconsistent.Objectives: We aimed to summarize available data on severity differences in acute cardiac injury and acute cardiac injury with mortality during the COVID-19 outbreak. Methods:We performed a systematic literature search across Pubmed, Embase and pre-print from December 1, 2019 to March 27, 2020, to identify all observational studies that reported cardiac specific biomarkers (troponin, creatine kinase-MB fraction, myoglobin, or NT-proBNP) during COVID-19 infection. We extracted data on patient demographics, infection severity, comorbidity history, and biomarkers during COVID-19 infection. Where possible, data were pooled for meta-analysis with standard (SMD) or weighted (WMD) mean difference and corresponding 95% confidence intervals (CI). Results:We included 4189 confirmed COVID-19 infected patients from 28 studies. More severe COVID-19 infection is associated with higher mean troponin (SMD 0.53, 95% CI 0.30 to 0.75, p<0.001), with a similar trend for creatine kinase-MB, myoglobin, and NT-proBNP.Acute cardiac injury was more frequent in those with severe, compared to milder, disease (risk ratio 5.99, 3.04 to 11.80; p<0.001). Meta regression suggested that cardiac injury biomarker differences of severity are related to history of hypertension (p = 0.030). Also COVID19-related cardiac injury is associated with higher mortality (summary risk ratio 3.85, 2.13 to 6.96; p<0.001). hsTnI and NT-proBNP levels increased during the course of hospitalization only in non-survivors. Conclusion:The severity of COVID-19 is associated with acute cardiac injury, and acute cardiac injury is associated with death. Cardiac injury biomarkers mainly increase in Journal Pre-proof J o u r n a l P r e -p r o o f non-survivors. This highlights the need to effectively monitor heart health to prevent myocarditis in patients infected with COVID-19. Journal Pre-proof J o u r n a l P r e -p r o o f Alphabetical list of abbreviations ACE2= angiotensin converting enzyme 2 CI = confidence intervals CK-MB = creatine kinase-MB COVID-19 = coronavirus disease 2019 hsTnI = hypersensitive troponin I NT-proBNP = N-terminal pro-B-type natriuretic peptide RR = risk ratio SARS-CoV = severe acute respiratory syndrome coronavirus SMD = standard mean difference WMD = weighted mean difference Journal Pre-proof J o u r n a l P r e -p r o o f Central illustration Journal Pre-proof Epidemiology (MOOSE) guidelines. 5 No language restrictions were imposed on the search. We searched the electronic databases Pubmed, and Embase from

The role of essential organ-based comorbidities in the prognosis of COVID-19 infection patients

“…Previous studies reported non-survivors present a higher proportion of various co-existing chronic illnesses in univariate analysis [4,[10][11][12]. Consistent with previous reports [10,13,14], our study indicated that COVID-19 patients with heart, liver, and kidney comorbidities had a higher risk of related organ injuries and death, compared with those without comorbidities. The cardiac, liver, and kidney complications can occur precipitously at any point during hospitalization and are increasingly being described as late complications that can occur after improvements in a patient's respiratory status.…”

Research Progress of Genetic Structure, Pathogenic Mechanism, Clinical Characteristics, and Potential Treatments of Coronavirus Disease 2019

“…It should be noted that compared to survived patients, cardiovascular disease is linked to a significantly increased risk of death in patients who have died (p < 0.001) ( Ruan et al, 2020 ). In parallel, dead cases had the higher levels of myoglobin and cardiac troponin, thus confirming relevant findings ( Li J. W. et al, 2020 ). Meanwhile, degeneration and necrosis of cardiomyocytes was found through sporadic autopsy and biopsy histopathology, and a few of monocytes, lymphocytes, and neutrophils infiltration could be seen in the cardiac myocyte ( Yao et al, 2020 ).…”

Cardiac manifestations in COVID‐19 patients—A systematic review

“…A meta‐analysis by Li et al cardiac biomarkers were significantly higher in severe cases compared to milder cases ( P < .001), this included troponin ( P < .001), CK‐MB ( P < .001) and NT‐proBNP ( P = .009) but myoglobin was not ( P = .052). Additionally, death was also higher in patients with acute cardiac injury ( P < .001) 62 …”