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

Jing-Wei Li, Tian-Wen Han, Mark Woodward, Craig S Anderson, Hao Zhou, Yun-Dai Chen, Bruce Neal

Journal: Progress in cardiovascular diseases 2020;63(4):518-524

PMID: 32305557

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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.

Address: 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: [email protected].; 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.

DOI: 10.1016/j.pcad.2020.04.008