We studied the frequency and the impact of various cardiovascular manifestations on in-hospital mortality in patients with COVID-19. The most common cardiovascular manifestation was the rise in Troponins, followed by abnormal ECG and chest pain. In addition, patients were diagnosed with Myocardial injury and Type II MI followed by STEMI and NSTEMI. The most common arrhythmia recorded was atrial fibrillation, followed by sinus bradycardia and Sinus tachycardia. Overall mortality was 67(14.3%). In addition, it was observed that CRP level was significantly associated with mortality, followed by raised Troponins, Urea, Creatinine and high WBC counts.
Khatib et al reported presence of hypertension and diabetes mellitus as the most common comorbidities in COVID-19 critically ill patients.14
Shi et al. studied 671 patients admitted to the hospital with severe COVID-19.15 A total of 62 patients (9.2%) died during admission. These patients more often had myocardial injuries than survivors. Both cardiovascular diseases and myocardial were observed in higher proportion among patients who died, indicating that underlying cardiac disease and cardiac complications lead to the development of the irreversible outcome. Coronary atherosclerotic plaque inflammation and vulnerability can also increase due to the systemic inflammatory response, increasing the risk of its rupture.16 In our study, we have noted a higher incidence of raised Troponins and myocardial injury in patients with COVID pneumonia, having a fatal outcome. It can be postulated that the presence of risk factors for CAD may increase the hazard of myocardial injury which can be further aggravated by pre-existing cardiac disease. We studied patients who required cardiac consultation due to cardiac symptoms, ECG changes, or raised Troponin levels. In our study, we observed a similar mortality rate of 14.3%. Furthermore, we also observed that mortality is associated with raised Troponins, CRP, Urea, and Creatinine.
Cardiac dysfunction has been reported as a leading of death in 27% of pneumonia-related deaths. In addition, cardiac complications lead to a 60% increase in pneumonia-related short-term mortality after baseline risk adjustment.17 Shi et al. reported potential risk factors for death, old age, chronic heart disease, increased inflammatory response, and myocardial injury.15 In our study, we observed that raised CRP level was significantly associated with mortality, followed by raised Troponins, Urea, Creatinine and high WBC counts.
Shi et al. noticed that the degree of inflammatory markers response, such as C-reactive protein and procalcitonin, were markedly increased, particularly among those patients who died.15
Fan et al. studied 73 patients with COVID-19, the patients who died in this study were older and had more chronic medical diseases. More severe lymphopenia developed among non-survivors, with mostly higher D-dimer, C-reactive protein, hs-Troponin I (hs-TnI), and interleukin-6 levels. Patients with high hs-TnI levels at the time of admission died faster.18 High hs-TnI level was associated with poor prognosis. Fan et al. 18 concluded that myocardial injury might occur early, which leads to increase mortality. It may be suggested that the inflammatory response and coagulation abnormality could be the possible mechanisms of COVID-19-related cardiac injury.
Wang et al. have reported that around 7.2% of patients developed a cardiac injury, whereas the rate of cardiac injury among ICU patients was even higher that reached approximately 22%.12
Chen et al. studied 54 patients with COVID-19. Sinus tachycardia was the most common arrhythmia observed in 23 severe and all critical patients. Ventricular tachycardia, atrioventricular block, and ventricular tachycardia were common in critical patients at the end stage. In our study, the most common arrhythmia recorded was atrial fibrillation, followed by sinus brady and tachycardia. In our study, heart failure requiring admission was observed in 2(0.4%) patients.19
COVID-19 patients with concomitant cardiovascular disease are likely to have a critical course and a higher death rate.20 Within the CVD category, coronary artery disease was markedly associated with worse outcomes.