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Observational Study
. 2020 Jul 1;5(7):811-818.
doi: 10.1001/jamacardio.2020.1017.

Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19)

Tao Guo  1 , Yongzhen Fan  1 , Ming Chen  1 , Xiaoyan Wu  1 , Lin Zhang  1 , Tao He  1 , Hairong Wang  1 , Jing Wan  1 , Xinghuan Wang  2 , Zhibing Lu  1
Affiliations
Observational Study

Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19)

Tao Guo et al. JAMA Cardiol. .

Erratum in

  • Error in Text.
    [No authors listed] [No authors listed] JAMA Cardiol. 2020 Jul 1;5(7):848. doi: 10.1001/jamacardio.2020.1722. JAMA Cardiol. 2020. PMID: 32432683 Free PMC article. No abstract available.

Abstract

Importance: Increasing numbers of confirmed cases and mortality rates of coronavirus disease 2019 (COVID-19) are occurring in several countries and continents. Information regarding the impact of cardiovascular complication on fatal outcome is scarce.

Objective: To evaluate the association of underlying cardiovascular disease (CVD) and myocardial injury with fatal outcomes in patients with COVID-19.

Design, setting, and participants: This retrospective single-center case series analyzed patients with COVID-19 at the Seventh Hospital of Wuhan City, China, from January 23, 2020, to February 23, 2020. Analysis began February 25, 2020.

Main outcomes and measures: Demographic data, laboratory findings, comorbidities, and treatments were collected and analyzed in patients with and without elevation of troponin T (TnT) levels.

Results: Among 187 patients with confirmed COVID-19, 144 patients (77%) were discharged and 43 patients (23%) died. The mean (SD) age was 58.50 (14.66) years. Overall, 66 (35.3%) had underlying CVD including hypertension, coronary heart disease, and cardiomyopathy, and 52 (27.8%) exhibited myocardial injury as indicated by elevated TnT levels. The mortality during hospitalization was 7.62% (8 of 105) for patients without underlying CVD and normal TnT levels, 13.33% (4 of 30) for those with underlying CVD and normal TnT levels, 37.50% (6 of 16) for those without underlying CVD but elevated TnT levels, and 69.44% (25 of 36) for those with underlying CVD and elevated TnTs. Patients with underlying CVD were more likely to exhibit elevation of TnT levels compared with the patients without CVD (36 [54.5%] vs 16 [13.2%]). Plasma TnT levels demonstrated a high and significantly positive linear correlation with plasma high-sensitivity C-reactive protein levels (β = 0.530, P < .001) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (β = 0.613, P < .001). Plasma TnT and NT-proBNP levels during hospitalization (median [interquartile range (IQR)], 0.307 [0.094-0.600]; 1902.00 [728.35-8100.00]) and impending death (median [IQR], 0.141 [0.058-0.860]; 5375 [1179.50-25695.25]) increased significantly compared with admission values (median [IQR], 0.0355 [0.015-0.102]; 796.90 [401.93-1742.25]) in patients who died (P = .001; P < .001), while no significant dynamic changes of TnT (median [IQR], 0.010 [0.007-0.019]; 0.013 [0.007-0.022]; 0.011 [0.007-0.016]) and NT-proBNP (median [IQR], 352.20 [174.70-636.70]; 433.80 [155.80-1272.60]; 145.40 [63.4-526.50]) was observed in survivors (P = .96; P = .16). During hospitalization, patients with elevated TnT levels had more frequent malignant arrhythmias, and the use of glucocorticoid therapy (37 [71.2%] vs 69 [51.1%]) and mechanical ventilation (31 [59.6%] vs 14 [10.4%]) were higher compared with patients with normal TnT levels. The mortality rates of patients with and without use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was 36.8% (7 of 19) and 21.4% (36 of 168) (P = .13).

Conclusions and relevance: Myocardial injury is significantly associated with fatal outcome of COVID-19, while the prognosis of patients with underlying CVD but without myocardial injury is relatively favorable. Myocardial injury is associated with cardiac dysfunction and arrhythmias. Inflammation may be a potential mechanism for myocardial injury. Aggressive treatment may be considered for patients at high risk of myocardial injury.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Correlation Between Plasma TnT and NT-proBNP With hsCRP
Plasma troponin T (TnT), high-sensitivity C-reactive protein levels (hsCRP), and N-terminal pro–brain natriuretic peptide (NT-pro BNP) collected on admission.
Figure 2.
Figure 2.. Mortality of Patients With Coronavirus Disease 2019 (COVID-19) With/Without Cardiovascular Disease (CVD) and With/Without Elevated Troponin T (TnT) Levels
Figure 3.
Figure 3.. Dynamic Changes of TnT and NT-proBNP During Hospitalization
The horizontal lines represent the median value in each group. NT-proBNP indicates N-terminal pro–brain natriuretic peptide; TnT, troponin T.
See this image and copyright information in PMC

Comment in

References

    1. Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: the mystery and the miracle. J Med Virol. 2020;92(4):401-402. doi:10.1002/jmv.25678 - DOI - PMC - PubMed
    1. Hui DS, I Azhar E, Madani TA, et al. . The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health: the latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2020;91:264-266. doi:10.1016/j.ijid.2020.01.009 - DOI - PMC - PubMed
    1. Paules CI, Marston HD, Fauci AS. Coronavirus infections: more than just the common cold. JAMA. Published online January 23, 2020. doi:10.1001/jama.2020.0757 - DOI - PubMed
    1. Wuhan Municipal Health Commission. Report of clustering pneumonia of unknown etiology in Wuhan City. Published December 31, 2019. Accessed January 31, 2020. http://wjw.wuhan.gov.cn/front/web/showDetail/2019123108989
    1. Huang C, Wang Y, Li X, et al. . Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5 - DOI - PMC - PubMed

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