Cardiac injury in COVID-19 patients associated with higher in-hospital mortality

Cardiac injury is common among patients hospitalized with COVID-19, according to new research out of Wuhan, China. The study, published in JAMA Cardiology, also found that cardiac injuries were associated with an increased risk of in-hospital mortality.

“Although a recent study reported that 12% of patients had COVID-19–associated acute cardiac injury, manifesting as an ejection fraction decline and troponin I elevation, and the American College of Cardiology clinical bulletin has highlighted the cardiac implications of COVID-19, the association between COVID-19–associated cardiac injury and risk of mortality remains unclear,” wrote lead author Shaobo Shi, MD, Renmin Hospital of Wuhan University in Wuhan, China, and colleagues. “The present study therefore retrospectively analyzed data from a single center in Wuhan, China, to examine the potential association between cardiac injury and mortality among patients with COVID-19.”

The study’s authors explored data from more than 400 patients who received care for COVID-19 in Wuhan, China, from Jan. 20 to Feb. 10, 2020. All patients were diagnosed according to an interim guidance developed by the World Health Organization, and cases where key cardiac biomarkers were absent were excluded altogether. The median age was 64 years old, and 50.7% of patients were female.

Overall, 19.7% of hospitalized COVID-19 patients had a cardiac injury. Fever (80.3%), cough (34.6%), shortness of breath (28.1%), fatigue (13.2%), sputum production (5.5%) and muscle ache (4.6%) were common symptoms. Less common symptoms included diarrhea, chest pain, sore throat, rhinorrhea and headache. In addition, 30.5% of hospitalized patients had hypertension, 14.4% had diabetes, 10.6% had coronary heart disease and 5.3% had cerebrovascular disease. Another 4.1% of study participants had chronic heart failure.

Patients with cardiac injury, the authors noted, were older and more likely to experience chest pain. Hypertension, diabetes, coronary heart disease, cerebrovascular disease, chronic heart failure, chronic obstructive pulmonary disease and cancer were all more common among patients with cardiac injury than those without.

Also, the authors noted, the mortality rate was 51.2% for patients with cardiac injuries, but just 4.5% for patients without.

“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,” the authors wrote.