Debra L. Beck and Eugene Braunwald, MD

Coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in considerable morbidity and mortality worldwide since December 2019. Understanding of the impact of pre-existing disease on COVID-19 and the impact of COVID-19 on cardiac health is limited. Shi et al conducted a single-center, observational study to explore the association between cardiac injury and mortality in patients with COVID-19.

A total of 416 patients hospitalized at Renmin Hospital of Wuhan University, Wuhan, China with laboratory-confirmed COVID-19 were included in the final analysis (mean age, 64 years, 50.7% female). Cardiac injury was defined as blood levels of high-sensitivity-cardiac troponin I above the 99^th percentile upper reference limit, regardless of new abnormalities in electrocardiography and echocardiography.

The majority of patients had fever (80.3%), followed by cough (34.6%) and shortness of breath (28.1%).

Cardiac injury was found in 19.7% of patients (n=82; median hs-TnI, 0.19 μg/L). Compared to those without cardiac injury, these patients were older (74 vs 60 years; p<0.001). They were also more likely to have hypertension (59.8% vs. 23.4%; p<0.001) and coronary artery disease (29.3% vs. 6.0%; P < .001).

Mechanical ventilation was required in 22.0% of those with cardiac injury (vs. 4.2% of those without; p<0.001). The incidence of acute respiratory distress syndrome was 58.5% and 14.7%, respectively (p<0.001).

Individuals with cardiac injury had a mortality rate of 51.2% compared to 4.5% for those without cardiac injury (p<0.001). In a regression model, patients with versus those without cardiac injury were at a higher risk of death (hazard ratio, 4.26).

Summary

In this observational study, cardiac injury was seen on almost one-quarter of patients hospitalized with COVID-19 and was associated with a markedly higher risk of in-hospital mortality.

References

Shi S, Qin M, Shen B, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020; published online March 25.

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