COVID-19 patients with cardiac injury showed higher rates of mortality than those without cardiac injury, according to study results published online Wednesday in JAMA Cardiology.
Shaobo Shi, MD, of Renmin Hospital of Wuhan University, China, and colleagues analyzed 416 patients with confirmed COVID-19 hospitalized in their institution. Of these, 82 patients (19.7%) had cardiac injury, and 334 patients (80.3%) did not. The authors defined cardiac injury as blood levels of cardiac biomarkers (specifically, high-sensitivity troponin I) above the 99th-percentile upper reference limit, regardless of new abnormalities in electrocardiography and echocardiography.
The study patients’ median age was 64 years (range, 21-95 years), and 211 (50.7%) were female. Among these patients, fever (334 patients [80.3%]) was the most common symptom. Compared with patients without cardiac injury, patients with cardiac injury were older (median age, 74 years vs. 60 years; P<0.001), and more likely to have chest pain (11 of 82 patients [13.4%] vs. 3 of 334 patients [0.9%]; P<0.001). Cardiac-injury patients had more comorbidities, including hypertension (59.8% vs. 23.4%), diabetes (24.4% vs. 12.0%), coronary heart disease (29.3% vs. 20 6.0%), and chronic heart failure (14.6% vs. 1.5%), in comparison to those without cardiac injury (all P<0.001), according to the study.
Higher percentages of patients with cardiac injury required noninvasive mechanical ventilation (46.3% vs 3.9%; P<0.001) or invasive mechanical ventilation (22.0% vs. 4.2%; P<0.001). Complications were more common in patients with cardiac injury, including acute respiratory distress syndrome (58.5% vs. 14.7%; P<0.001), acute kidney injury (8.5% vs. 0.3%; P<0.001), and coagulation disorders (7.3% vs. 1.8%; P=0.02).
Patients with cardiac injury had a higher mortality rate than those without cardiac injury (42 of 82 [51.2%] vs. 15 of 334 [4.5%]; P<0.001). Cardiac-injury patients were at a higher risk of death, both during the time from symptom onset (hazard ratio [HR] 4.26; 95% confidence interval [CI], 1.92-9.49) and from admission to end point (HR, 3.41; 95% CI, 1.62-7.16).
“Although the exact mechanism of cardiac injury needs to be further explored, the findings presented here highlight the need to consider this complication in COVID-19 management,” Shi and colleagues concluded.
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. doi:10.1001/jamacardio.2020.0950