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Arch Iran Med. 2020;23(11): 801-812.
doi: 10.34172/aim.2020.107
  Abstract View: 128
  PDF Download: 66

COVID-19

Systematic Review

Acute Cardiac Injury in COVID-19: A Systematic Review and Meta-analysis

Mehrbod Vakhshoori 1 ORCID logo, Maryam Heidarpour 2, Davood Shafie 1* ORCID logo, Marzieh Taheri 3, Nima Rezaei 4,5,6 ORCID logo, Nizal Sarrafzadegan 7

1 Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
2 Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
4 Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
5 Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
6 Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
7 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
*Corresponding Author: Davood Shafie, MD; Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran. Tel: 0098-913-318-8054; Email: d.shafie87@gmail.com

Abstract

Background: Coronavirus disease 2019 (COVID-19) has been widespread since late December 2019, with several symptoms related to the upper and lower respiratory system. However, its cardiac manifestations are less frequently studied. We aimed to analyze the available COVID-19 data on acute cardiac injury, using troponin and brain natriuretic peptide (BNP) levels.

Methods: We performed a systematic review on Medline/PubMed, Scopus, and Google Scholar databases until March 25, 2020. Relevant records reporting the incidence of acute cardiac injury as well as troponin and BNP levels were collected from published peer-reviewed articles with further analysis according to the clinical status of the patients (severe, non-severe, and death).

Results: Eleven records of 1394 individuals were included. The mean age of patients with acute cardiac injury was 56.6 ± 33.4 years (males: 54.3%). The incidence of acute cardiac injury was 15% (95% CI: 11, 20%). Further analysis revealed that dead or severe patients had significantly higher percentages of myocardial injury, compared to non-severe ones (peer-reviewed: 44%, 95% CI: 16, 74% vs. 24%, 95% CI: 15, 34% vs. 5%, 95% CI: 1, 12%, respectively). Mean total troponin was 10.23 pg/mL (95% CI: 5.98, 14.47), while 13% (95% CI: 8%, 18%) of patients had elevated levels. Mean BNP was 216.74 pg/mL (95% CI: 3.27, 430.20).

Conclusion: Acute cardiac injury in COVID-19 patients is more frequent than what was expected at the beginning of the outbreak. Meanwhile, further studies are needed to investigate the utility of cardiac biomarkers as diagnostic and prognostic tools for long-term cardiac complications of this infection.

Keywords: Brain, Heart injuries, COVID-19, Coronavirus, Natriuretic peptide, Troponin
Cite this article as: Vakhshoori M, Heidarpour M, Shafie D, Taheri M, Rezaei N, Sarrafzadegan N. Acute cardiac injury in COVID-19: a systematic review and meta-analysis. Arch Iran Med. 2020;23(11):801–812. doi: 10.34172/aim.2020.107.
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Submitted: 12 May 2020
Accepted: 06 Sep 2020
ePublished: 01 Nov 2020
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