Acute Myocardial Injury of Patients with Coronavirus Disease 2019

  1. Huayan Xu
  2. Keke Hou
  3. Hong Xu
  4. Zhenlin Li
  5. Huizhu Chen
  6. Na Zhang
  7. Rong Xu
  8. Hang Fu
  9. Ran Sun
  10. Lingyi Wen
  11. Linjun Xie
  12. Hui Liu
  13. Kun Zhang
  14. Joseph B. Selvanayagam
  15. Chuan Fu
  16. Shihua Zhao
  17. Zhigang Yang
  18. Ming Yang
  19. Yingkun Guo

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Abstract

Background

Since the outbreak of the Coronavirus Disease 2019 (COVID-19) in China, respiratory manifestations of the disease have been observed. However, as a fatal comorbidity, acute myocardial injury (AMI) in COVID-19 patients has not been previously investigated in detail. We investigated the clinical characteristics of COVID-19 patients with AMI and determined the risk factors for AMI in them.

Methods

We analyzed data from 53 consecutive laboratory-confirmed and hospitalized COVID-19 patients (28 men, 25 women; age, 19–81 years). We collected information on epidemiological and demographic characteristics, clinical features, routine laboratory tests (including cardiac injury biomarkers), echocardiography, electrocardiography, imaging findings, management methods, and clinical outcomes.

Results

Cardiac complications were found in 42 of the 53 (79.25%) patients: tachycardia (n=15), electrocardiography abnormities (n=11), diastolic dysfunction (n=20), elevated myocardial enzymes (n=30), and AMI (n=6). All the six AMI patients were aged >60 years; five of them had two or more underlying comorbidities (hypertension, diabetes, cardiovascular diseases, and chronic obstructive pulmonary disease). Novel coronavirus pneumonia (NCP) severity was higher in the AMI patients than in patients with non-definite AMI (p<0.001). All the AMI patients required care in intensive care unit; of them, three died, two remain hospitalized. Multivariate analyses showed that C-reactive protein (CRP) levels, NCP severity, and underlying comorbidities were the risk factors for cardiac abnormalities in COVID-19 patients.

Conclusions

Cardiac complications are common in COVID-19 patients. Elevated CRP levels, underlying comorbidities, and NCP severity are the main risk factors for cardiac complications in COVID-19 patients.

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  1. ScreenIT

    SciScore for 10.1101/2020.03.05.20031591: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Study population: The institutional ethics board of our institutes approved this study (No. 2020.43).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    13 Statistical analysis: Statistical analysis was performed using SPSS version 21.0 (Armonk,
    SPSS
    suggested: (SPSS, RRID:SCR_002865)
    ; Graphpad version 7.00, San Diego, CA).
    Graphpad
    suggested: (GraphPad, RRID:SCR_000306)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has some limitations. First, this is a modest-size case series of hospitalized COVID-19 patients; more standardized data from a larger cohort would beneficial for further determining the clinical characteristics. Second, our data showed the clinical characteristics of AMI induced by COVID-19, including the clinical presentations, electrophysiological abnormality, myocardial enzyme and myocardial injury marker levels, and cardiac dysfunction and enlargement. However, the tissue characteristics in myocardial damage (i.e., edema, fibrosis, and microcirculation disorder) should be further demonstrated via cardiac magnetic resonance imaging examination as far as possible under the premise of controlling transmission. Finally, most of the COVID-19 patients with AMI had severe or critically severe NCP and high fatality rate, but long-term follow-up should be performed to determine adverse cardiac events in the patients who could not be diagnosed with MI but had elevated levels of one or more myocardial enzymes and myocardial injury markers. In summary, we found that cardiovascular complications are common in COVID-19 patients and include tachycardia, elevated myocardial enzyme levels, cardiac dysfunction, and even AMI. More importantly, CRP level elevation, NCP severity, and underlying cardiovascular diseases are the major risk factors for AMI in these patients.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.03.05.20031591v1 on medRxiv