Clinical Characteristics and Risk Factors of Cardiac Involvement in COVID-19

Abstract

Background Increasing studies demonstrated that the cardiac involvements are related to coronavirus disease 2019 (COVID-19). Thus, we investigated the clinical characteristics of patients with COVID-19 and further determined the risk factors for cardiac involvement in them. Methods and Results We analyzed data from 102 consecutive laboratory-confirmed and hospitalized patients with COVID-19 (52 women aged 19-87 years). Epidemiologic and demographic characteristics, clinical features, routine laboratory tests (including cardiac injury biomarkers), echocardiography, electrocardiography, chest imaging findings, management methods, and clinical outcomes were collected. Patients were divided into acute cardiac injury, with and without cardiac marker abnormities groups according to different level of cardiac markers. In this research, cardiac involvement was found in 72 of the 102 (70.6%) patients: tachycardia (n=20), electrocardiography abnormalities (n=23), echocardiography abnormalities (n=59), elevated myocardial enzymes (n=55), and acute cardiac injury (n=9). Eight patients with acute cardiac injury were aged >60 years; seven of them had ≥2 underlying comorbidities (hypertension, diabetes mellitus, cardiovascular diseases, chronic obstructive pulmonary disease, and chronic kidney disease). Novel coronavirus pneumonia was much more severe in the patients with acute cardiac injury than in patients with nondefinite acute cardiac injury (P<0.001). Multivariate analyses showed that CRP (C-reactive protein) levels, old age, novel coronavirus pneumonia severity, and underlying comorbidities were the risk factors for cardiac abnormalities in patients with COVID-19. Conclusions Cardiac involvements are common in patients with COVID-19. Elevated CRP levels, old age, underlying comorbidities, and novel coronavirus pneumonia severity are the main risk factors for cardiac involvement in patients with COVID-19. More attention should be given to cardiovascular protection during COVID-19 treatment for mortality reduction. Registration URL: https://www.chictr.org; Unique identifier: ChiCTR2000029955.

Keywords: COVID‐19; acute cardiac injury; cardiac involvement; risk factor.

Figure 1. Comorbidities in patients with COVID‐19.

In patients with ACI, hypertension and cardiovascular diseases were the frequently occurring comorbidities. ACI indicates acute cardiac injury; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary diseases; and COVID‐19, coronavirus disease 2019.

Figure 2. CT features of NCP in patient with COVID‐19.

A, Patient with ACI with critically severe NCP showed bilateral infiltration mainly representing as consolidation and ground glass opacity in both lungs. B, Ground‐glass opacity and reticulation were observed in both lung of a case with cardiac marker abnormality with server type NCP. C, Patchy ground‐glass opacity shown in the patients with common‐type NCP without cardiac marker abnormality. ACI indicates acute cardiac injury; COVID‐19, coronavirus disease 2019; CT, computed tomography; and NCP, novel coronavirus pneumonia.

Figure 3. Heterogeneity of NCP types in patients with COVID‐19.

ACI indicates acute cardiac injury; COVID‐19, coronavirus disease 2019; and NCP, novel coronavirus pneumonia.