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Meta-Analysis
. 2020 Jul-Aug;63(4):518-524.
doi: 10.1016/j.pcad.2020.04.008. Epub 2020 Apr 16.

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

Jing-Wei Li  1 , Tian-Wen Han  2 , Mark Woodward  3 , Craig S Anderson  4 , Hao Zhou  2 , Yun-Dai Chen  5 , Bruce Neal  6
Affiliations
Meta-Analysis

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

Jing-Wei Li et al. Prog Cardiovasc Dis. 2020 Jul-Aug.

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.

Keywords: COVID-19; Cardiac injury; Coronavirus; Mortality.

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Conflict of interest statement

Declaration of competing interest BN is supported by an Australian National Health and Medical Research Council Principal Research Fellowship; holds a research grant for this study from Janssen; and has held research grants for other large­scale cardiovascular outcome trials from Roche, Servier, and Merck Schering Plough; and his institution has received consultancy, honoraria, or travel support for contributions he has made to advisory boards or the continuing medical education programmes of Abbott, Janssen, Novartis, Pfizer, Roche, and Servier. MW is a consultant for Amgen, Inc., and Kirin. CA holds a NHMRC Senior Principal Research Fellowship and has received fees from Boehringer Ingelheim and Amgen for participating in advisory panels, from Takeda China and Boehringer Ingelheim for speaking at seminars, and a research grant from Takeda China paid to his institution. The other authors have no disclosures.

Figures

Unlabelled Image
Graphical abstract
Fig. 1
Fig. 1
Forest plots of cardiac biomarkers change between more severe and less cases of COVID-19. SMD, standard mean difference.
Fig. 2
Fig. 2
Meta-regression of standard mean difference for difference of hypertension history on cardiac injury biomarker (more severe vs. less severe, p = 0.030).
Fig. 3
Fig. 3
Forest plots showing risk ratio (RR) for death according to acute cardiac injury (yes vs. no).
Fig. 4
Fig. 4
Forest plots showing risk ratio (RR) for death according to severity of COVID-19 (more severe vs. less).
Fig. 5
Fig. 5
Combined time series change of hs-Troponin I (a) and NT-proBNP (b).
See this image and copyright information in PMC

Comment in

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