The Heart and COVID-19: What Cardiologists Need to Know

Costa, Isabela Bispo Santos da Silva; Bittar, Cristina Salvadori; Rizk, Stephanie Itala; Araújo Filho, Antônio Everaldo de; Santos, Karen Alcântara Queiroz; Machado, Theuran Inahja Vicente; Andrade, Fernanda Thereza de Almeida; González, Thalita Barbosa; Arévalo, Andrea Nataly Galarza; Almeida, Juliano Pinheiro de; Bacal, Fernando; Oliveira, Gláucia Maria Moraes de; Lacerda, Marcus Vinícius Guimarães de; Barberato, Silvio Henrique; Chagas, Antonio Carlos Palandri; Rochitte, Carlos Eduardo; Ramires, José Antonio Franchini; Kalil Filho, Roberto; Hajjar, Ludhmila Abrahão

doi:10.36660/abc.20200279

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Review Article • Arq. Bras. Cardiol. 114 (5) • May 2020 • https://doi.org/10.36660/abc.20200279 copy

The Heart and COVID-19: What Cardiologists Need to Know

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

In face of the pandemic of the novel coronavirus disease 2019 (COVID-19), the management of patients with cardiovascular risk factors and/or disease is challenging. The cardiovascular complications evidenced in patients with COVID-19 derive from several mechanisms, ranging from direct viral injury to complications secondary to the inflammatory and thrombotic responses to the infection. The proper care of patients with COVID-19 requires special attention to the cardiovascular system aimed at better outcomes.

Coronavirus; COVID-19; Cardiovascular Diseases/complications; Heart/physiopathology; Pandemics; Respiratory Distress Syndrome, Adult; Risk Factors; Patient Care

Author	N	Type	Age (years)	Comorbidities	Major findings
Huang et al. 2020¹⁷	41	Prospective	49 (41-58)	- DM: 8 (20%) - AH: 6 (15%) - CVD: 6 (15%) - COPD: 1 (2%) - Cancer: 1 (2%)	- 13 (32%) ICU admissions - 5 (12%) MI, and 4 (31%) to the ICU - 3 (7%) shock and 12 (29%) ARDS - Mortality: 6 (15%)
Wang et al. 2020³⁰	69	Retrospective	42 (35-62)	- AH: 9 (13%) - CVD: 8 (12%) - DM: 7 (10%) - COPD: 4 (6%) - Cancer: 4 (6%)	- Hospitalizations: 44 (65.7%) - Mortality: 5 (7.5%) - Patients with DM, AH and CVD more often had hypoxemia (SatO₂< 90%) - MI not assessed
Chen et al. 2020³¹	99	Retrospective	55 (21-82)	- CVD: 40 (40%) - DM: 12 (12%) - Cancer: 1 (1%)	- 57 (58%) hospitalizations, 17 (17%) ARDS, 4 (4%) shock - Mortality: 11 (11%) - Of the deceased, 63% were > 60 years and 33% had AH
Wang et al. 2020⁹	138	Retrospective	56 (42-68)	- AH: 43 (31.2%) - CVD: 20 (14.5%) - DM: 14 (10.1%) - Cancer: 10 (7.2%) - Stroke: 7 (5.1%)	- 36 (26%) ICU admissions, high prevalence of risk factors - 12 (8.7%) shock, 23 (16.7%) arrhythmias, 27 (19.6%) ARDS, and 10 (7.2%) MI - Mortality: 6 (4.3%)
Zhang et al. 2020²⁹	140	Retrospective	57 (20–83)	- AH: 42 (30%) - DM: 17 (12.1%) - CAD: 7 (5%) - Arrhythmias: 5 (3.6%)	- Comparing severe x non-severe groups: median age 64 vs 51.5, p < 0.001 comorbidities 79.3% vs 53.7%, p = 0.002 d-dimer 0.4 vs 0.2, p<0.001
Guo et al. 2020¹⁰	187	Retrospective	58.5 (±14.7)	- AH: 61 (32.6%) - CAD: 21 (11.2%) - HF: 8 (4.3%) - DM: 28 (15%) - COPD: 4 (2.1%) - Cancer: 13 (7%)	- 52 (27.8%) MI - Comparing normal tropo x high tropo: AH: 27% vs 63.5%, p 0.001 CAD: 3% vs 32.7%, p <0.001 HF: 0% vs 15.4%, p <0.001 - 43 deaths, 31 (59.6%) in the MI group - Mortality: 13.3% CVD without MI, and 69.4% CVD with MI
Zhou et al 2020¹²	191	Retrospective	56 (46-67)	- AH: 58 (30%) - DM: 36 (19%) - CAD: 15 (8%) - COPD: 6 (3%) - Cancer: 2(1%)	- MI: 24/145 (17%), greater in patients who died (22.2 [5.6-83.1] vs 3.0 [1.1-5.5], p <0.001) - HF 44 (23%), shock 38 (20%), ARDS 59 (31%) - 54 (28%) deaths, 67% with comorbidities
Shi et al. 2020¹¹	416	Prospective	64 (21-95)	- AH: 127 (30.5%) - DM: 60 (14.4%) - CAD: 44 (10.6%) - Stroke: 22 (5.3%) - HF: 17 (4.1%) - Cancer: 9 (2.2%)	- 82 (19.7%) MI - High prevalence of AH, DM, CAD and HF in patients with MI - MI was related to higher mortality: (42 of 82 [51.2%] vs 15 of 334 [4.5%]; p < .001) - MI was associated with ARDS: (48 of 82 [58.5%] vs 49 of 334 [14.7%]; p < .001)
Guan et al. 2020³²	1099	Retrospective	47 (35-58)	- COPD: 12 (1.1%) - DM: 81 (7.4%) - AH: 165 (15%) - CAD: 27 (2.5%) - Stroke: 15 (1.4%) - Câncer: 10 (0.9%)	- Severely-ill patients: AH 41 (23.7%) - High CK-MB 90/657 (13.7%) - 12 (1.1%) shock, 37 (3.4%) ARDS, 1029 (93.6%) hospitalizations, 55 (5%) ICU admissions - Mortality: 15 (1.4%)

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[1] Mailing Adddress: Ludhmila Abrahão Hajjar • Universidade de São Paulo Instituto do Câncer do Estado de São Paulo – Av. Dr. Arnaldo, 251. CEP 01246-000, São Paulo, SP – Brazil E-mail: ludhmila@usp.br