COVID-19 and its impact on the cardiovascular system

Abstract

Objectives: The clinical impact of SARS-CoV-2 has varied across countries with varying cardiovascular manifestations. We review the cardiac presentations, in-hospital outcomes and development of cardiovascular complications in the initial cohort of SARS-CoV-2 positive patients at Imperial College Healthcare National Health Service Trust, UK.

Methods: We retrospectively analysed 498 COVID-19 positive adult admissions to our institute from 7 March to 7 April 2020. Patient data were collected for baseline demographics, comorbidities and in-hospital outcomes, especially relating to cardiovascular intervention.

Results: Mean age was 67.4±16.1 years and 62.2% (n=310) were male. 64.1% (n=319) of our cohort had underlying cardiovascular disease (CVD) with 53.4% (n=266) having hypertension. 43.2%(n=215) developed acute myocardial injury. Mortality was significantly increased in those patients with myocardial injury (47.4% vs 18.4%, p<0.001). Only four COVID-19 patients had invasive coronary angiography, two underwent percutaneous coronary intervention and one required a permanent pacemaker implantation. 7.0% (n=35) of patients had an inpatient echocardiogram. Acute myocardial injury (OR 2.39, 95% CI 1.31 to 4.40, p=0.005) and history of hypertension (OR 1.88, 95% CI 1.01 to 3.55, p=0.049) approximately doubled the odds of in-hospital mortality in patients admitted with COVID-19 after other variables had been controlled for.

Conclusion: Hypertension, pre-existing CVD and acute myocardial injury were associated with increased in-hospital mortality in our cohort of COVID-19 patients. However, only a low number of patients required invasive cardiac intervention.

Keywords: acute coronary syndrome; arrhythmias; cardiac; myocardial disease; myocarditis.

Figure 1

COVID-19 patient presenting with STEMI. Severe disease in RCA (A) and LAD (B). Treated with PCI from LMS to LAD (C). LAD, left anterior descending; LMS, left main stem; PCI, percutaneous coronary intervention; RCA, right coronary artery; STEMI, ST elevation myocardial infarction.

Figure 2

Cardiac MRI of a patient following a troponin rise during COVID-19 infection. The top row shows T2 maps, in which there are several areas of increased signal suggestive of recent myocardial injury (white arrows). The bottom row shows dark-blood late gadolinium enhancement images in which the myocardium should be dark grey. The three red arrows indicate separate areas of high signal which are multiple small myocardial infarctions in the basal inferoseptal, mid-inferolateral and apical inferior segments of the left ventricle. The blue arrow indicates subepicardial late gadolinium enhancement which may indicate a myocarditic process.