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

Department of Cardiology, People's Liberation Army General Hospital, Beijing, China; The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia; Department of Cardiology, Xinqiao Hospital, Army Military Medical University, Chongqing, China. Department of Cardiology, People's Liberation Army General Hospital, Beijing, China. The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia; The George Institute for Global Health, University of Oxford, Oxford, UK; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA. The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia; The George Institute China at Peking University Health Science Center, Beijing, PR China; Heart Health Research Center, Beijing, China. Department of Cardiology, People's Liberation Army General Hospital, Beijing, China. Electronic address: cyundai@vip.163.com. The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia; Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia; Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom.

Progress in cardiovascular diseases. 2020;(4):518-524
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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 non-survivors. This highlights the need to effectively monitor heart health to prevent myocarditis in patients infected with COVID-19.

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Publication Type : Meta-Analysis

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