• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • 0 CME Hours
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
COVID-19 Clinical Features

Cardiac Injury: A Feature of COVID-19

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • It appears that some patients with COVID-19 have acute cardiac injury
    • Ejection fraction decline | hs-TNI elevation
    • Unclear whether cardiac findings alter outcome
    • Shi et al. (JAMA Cardiology, 2020) examined the association between cardiac injury and mortality in patients with COVID-19

METHODS:

  • Cohort study
  • Setting
    • A hospital in Wuhan, China | From January 20 to February 10, 2020
  • Participants
    • Consecutive inpatients with laboratory-confirmed COVID-19
  • Study design
    • Clinical laboratory, radiological, and treatment data were collected and analyzed
    • Cardiac injury definition: Cardiac biomarkers (e.g., hs-TNI) above the 99th-percentile upper reference limit, regardless of new abnormalities in electrocardiography and echocardiography
    • Clinical outcomes compared between patients with and without cardiac injury, with focus on morality rates
    • Adjusted Cox proportional hazard regression model was used, with adjustment for multiple confounders, including age, preexisting cardiovascular, diabetes ARDS and other related disorders

RESULTS:

  • 416 patients with confirmed COVID-19
    • Median Age: 64 years (range between 21 and 95 years) | 50.7% female
  • Common symptoms
    • Fever: 80.3%
    • Cough: 34.6%
    • Shortness of breath: 28.1%
    • Additional symptoms included fatigue and muscle aches | Diarrhea, chest pain, sore throat. rhinorrhea and headache were also present, but much less common (frequency 3.8% or less)
    • Chest pain was significantly more frequent in cardiac injury group, but only occurred in a minority of patients (13.4% vs 0.9%)
  • Cardiac injury: 19.7% of confirmed COVID-19 patients
  • Patients with cardiac injury
    • Were older
      • Median age: 74 vs 60 years; P < 0.001
    • Had more comorbidities (eg, hypertension, diabetes, CAD etc.)
      • 59.8% vs 23.4%; P < 0.001
      • There were 7 patients who were pregnant, all in the non-cardiac injury cohort
    • Additional lab abnormalities: Leukocyte counts | CRP | Procalcitonin | CK–MB | Myohemoglobin | (hs-TNI) | N-terminal pro-B-type natriuretic peptide | Aspartate aminotransferase | Creatinine
  • Chest radiographic findings were more common in those with cardiac injury
    • Multiple mottling and ground-glass opacity: 64.6% vs 4.5%; P<0.001
  • A greater proportion of patients with cardiac injury received
    • Noninvasive mechanical ventilation: 46.3% vs 3.9%; P < 0.001
    • Invasive mechanical ventilation: 22.0% vs 4.2%; P < 0.001
  • Complications were more common in patients with cardiac injury
    • ARDS: 58.5% vs 14.7%; P < 0.001
    • Acute kidney injury: 8.5% vs 0.3%; P < 0.001
    • Electrolyte disturbances: 15.9% vs 5.1%; P = 0.003
    • Hypoproteinemia: 13.4% vs 4.8%; P = 0.01
    • Coagulopathies: 7.3% vs 1.8%; P = 0.02
  • Mortality Rate
    • Patients with cardiac injury had higher mortality: 51.2% vs 4.5%; P < 0.001
    • Mortality increased with hs-TNI levels | ARDS was an independent risk factor for mortality
    • After adjusting for confounders, those with cardiac injury were at higher risk of death
      • During time from symptom onset to study endpoint: Hazard ratio (HR) 4.26; 95% CI, 1.92-9.49
      • Time from admission to study end point: HR, 3.41; 95% CI, 1.62-7.16

CONCLUSION:

  • Cardiac injury is common (approximately 20%) and associated with “an unexpected high risk of mortality during hospitalization”
  • While the mechanism remains unclear, the authors caution that

…the findings presented here highlight the need to consider this complication in COVID-19 management

Learn More – Primary Sources:

Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China

Get COVID-19 Research Summaries Direct to Your Phone, with ObGFirst

Try it Free »

image_pdfFavoriteLoadingFavorite
< Previous
All COVID-19 Clinical Features Posts
Next >

Related ObG Topics:

Washington State’s First COVID-19 Cases: Outcomes and Characteristics of 21 Critically Ill Patients
MMWR Reports on Initial US COVID-19 Experience: Demographics, Mortality and Outcomes 
ARDS, Critical Care and COVID-19: ‘Surviving Sepsis Campaign’ Guidelines and Key Points

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • #Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

ObG Library

  • Hysteroscopy
  • Fertility
  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Log In to ObG First

Please log in to access OBGFirst and the 2T Ultrasound Atlas

Password Trouble?

Sign Up for ObGFirst

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!

ObG First Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site