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Meta-Analysis
. 2021 Sep 1;49(9):1558-1566.
doi: 10.1097/CCM.0000000000005026.

Acute Cardiac Injury in Coronavirus Disease 2019 and Other Viral Infections-A Systematic Review and Meta-Analysis

Matthew P Cheng  1 , Alessandro Cau  2 , Todd C Lee  1 , Daniel Brodie  3 , Arthur Slutsky  4 , John Marshall  4 , Srin Murthy  5 , Terry Lee  6 , Joel Singer  6 , Koray K Demir  1 , John Boyd  7 , Hyejee Ohm  2 , David Maslove  8 , Alberto Goffi  9 , Isaac I Bogoch  10 , David D Sweet  11 , Keith R Walley  7 , James A Russell  7 ; Angiotensin Receptor Blocker Coronavirus Study (ARBs) CORONA I
Affiliations
Meta-Analysis

Acute Cardiac Injury in Coronavirus Disease 2019 and Other Viral Infections-A Systematic Review and Meta-Analysis

Matthew P Cheng et al. Crit Care Med. .

Abstract

Objectives: Severe acute respiratory syndrome-related coronavirus-2 binds and inhibits angiotensin-converting enzyme-2. The frequency of acute cardiac injury in patients with coronavirus disease 2019 is unknown. The objective was to compare the rates of cardiac injury by angiotensin-converting enzyme-2-binding viruses from viruses that do not bind to angiotensin-converting enzyme-2.

Data sources: We performed a systematic review of coronavirus disease 2019 literature on PubMed and EMBASE.

Study selection: We included studies with ten or more hospitalized adults with confirmed coronavirus disease 2019 or other viral pathogens that described the occurrence of acute cardiac injury. This was defined by the original publication authors or by: 1) myocardial ischemia, 2) new cardiac arrhythmia on echocardiogram, or 3) new or worsening heart failure on echocardiogram.

Data extraction: We compared the rates of cardiac injury among patients with respiratory infections with viruses that down-regulate angiotensin-converting enzyme-2, including H1N1, H5N1, H7N9, and severe acute respiratory syndrome-related coronavirus-1, to those with respiratory infections from other influenza viruses that do not bind angiotensin-converting enzyme-2, including Influenza H3N2 and influenza B.

Data synthesis: Of 57 studies including 34,072 patients, acute cardiac injury occurred in 50% (95% CI, 44-57%) of critically ill patients with coronavirus disease 2019. The overall risk of acute cardiac injury was 21% (95% CI, 18-26%) among hospitalized patients with coronavirus disease 2019. In comparison, 37% (95% CI, 26-49%) of critically ill patients with other respiratory viruses that bind angiotensin-converting enzyme-2 (p = 0.061) and 12% (95% CI, 7-22%) of critically ill patients with other respiratory viruses that do not bind angiotensin-converting enzyme-2 (p < 0.001) experienced a cardiac injury.

Conclusions: Acute cardiac injury may be associated with whether the virus binds angiotensin-converting enzyme-2. Acute cardiac injury occurs in half of critically ill coronavirus disease 2019 patients, but only 12% of patients infected by viruses that do not bind to angiotensin-converting enzyme-2.

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Conflict of interest statement

Dr. Cheng’s institution received funding from Canadian Institutes of Health Research (CIHR), and he disclosed being on the scientific advisory board of GEN1E LifeSciences. Dr. Lee received funding from Fonds de Recherche du Québec Santé. Dr. Brodie’s institution received funding from ALung Technologies, and he received funding from Baxter, Xenios, BREETHE, and Hemovent. Dr. Slutsky received funding from Apeiron Biologics (which is investigating recombinant angiotensin-converting enzyme 2 as a treatment for coronavirus disease 2019 [COVID-19]). Dr. Marshall received funding from AM Pharma and AKPA Pharma. Dr. Bogoch received funding from BlueDot. Dr. Russell received funding from Asahi Kesai Pharmaceuticals of America, SIB Therapeutics, Ferring Pharmaceuticals, and previously received funding for consulting for La Jolla Pharmaceuticals and PAR Pharma. Dr. Russell reports patents owned by the University of British Columbia (UBC) that are related to the use of PCSK9 inhibitor(s) in sepsis and related to the use of vasopressin in septic shock, and he is an inventor on these patents. Dr. Russell was a founder, Director, and shareholder in Cyon Therapeutics Inc. and is a shareholder in Molecular You Corp. Dr. Russell reports having received an investigator-initiated grant from Grifols (entitled “Is HBP a mechanism of albumin’s efficacy in human septic shock?”) that was provided to and administered by UBC. Dr. Russell received support for article research from the CIHR. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

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