Patients with underlying heart conditions are at even greater risk for death due to the coronavirus disease 2019 (COVID-19), and even those without underlying cardiac conditions can experience cardiac injury according to a review published in JAMA Cardiology.
While COVID-19 is most known for affecting the lungs, underlying cardiovascular disease or cardiac risk factors could lead to worse outcomes. The investigators noted that the high inflammatory burden can induce severe cardiac-related problems such as vascular inflammation, myocarditis, and cardiac arrhythmias.
According to the researchers, the case fatality rate for patients with COVID-19 and cardiovascular disease is 10.5%. Other data has suggested that individuals aged 65 years or older with coronary heart disease or hypertension can experience more severe symptoms if they are infected.
While most of the data have been anecdotal, the researchers noted several studies’ findings regarding patients hospitalized with Severe Acute Respiratory Syndrome (SARS). In a study of 75 patients, acute myocardial infarction was the cause of death in 2 of 5 fatal cases. Another prospective study of 46 patients with SARS and without preexisting cardiac disease found no significant change in systolic function 30 days after the acute stage of infection, but noted that transient diastolic function was detected during infection and resolved during followup.
In another study of 121 patients, 12 of whom had underlying cardiovascular disease, tachycardia was the most common finding (72%), and other complications included hypotension (50%), bradycardia (15%), transient cardiomegaly (11%), and transient paroxysmal atrial fibrillation, in only 1 patient.
Perhaps most notably, the authors noted that severe cases of COVID-19 appear to involve myocarditis, an inflammation of the heart muscle. Some cases of severe myocarditis with reduced systolic function have been reported in patients who have recovered from COVID-19, and cardiac biomarker studies have suggested a high prevalence of cardiac injury in hospitalized patients.
Several studies in China have noted the importance of cardiac injury in COVID-19 mortality. One study of 416 hospitalized patients found that of 57 who died, 10.6% had coronary heart disease, 4.1% had heart failure, and 5.3% had cerebrovascular disease.
Another study of the factors associated with outcomes in 187 patients hospitalized with COVID-19 found that 35% had underlying cardiovascular disease, and 28% showed evidence of acute myocardial injury. In this study, acute myocardial injury was defined as elevated troponin T (TnT) greater than the 99th percentile upper limit, and the researchers noted that those with high TnT has significantly higher mortality rates.
Based on their review of current data, the authors concluded that significant cardiovascular complications are expected among patients with COVID-19. They also urged experts to begin creating a prospective registry of patients with a systematic recording of clinical variables and cardiovascular complications, and added that this would be beneficial to identifying the pattern of complications, developing a risk model, and predict various patients’ responses to treatment modalities.
Madjid M, Safavi-Naeini P, Solomon S, Vardeny O. Potential Effects of Coronaviruses on the Cardiovascular System. JAMA Cardiology; March 27, 2020. https://jamanetwork.com/journals/jamacardiology/fullarticle/2763846. Accessed March 30, 2020.