COVID-19 Heart Injury Associated With Poorer Outcomes, Studies Show

By Steven Li, MD | March 2, 2021
Steven Li is a medical professional with a passion for lifelong learning and spreading positivity and truth to the world. He has a Doctor of Medicine (MD) degree and a passion for business and marketing, cultivated through healthcare and technology-related consulting projects. He also has a love for music and the performing arts.
Coronavirus disease 2019 (COVID-19) patients with heart damage have worse clinical outcomes, more severe disease, more intensive care unit (ICU) admissions, and a higher risk of all-cause mortality, according to two meta-analyses conducted by Chinese researchers.

Coronavirus disease 2019 (COVID-19) patients with heart injury have worse clinical outcomes, more severe disease, more intensive care unit (ICU) admissions, and a higher risk of all-cause mortality, according to two meta-analyses conducted by Chinese researchers.

COVID-19 continues to wreak havoc across the globe. A Feb. 23 status update by the World Health Organization (WHO) shows more than 110.7 million cases and over 2.4 million deaths worldwide since the start of the pandemic. Mutant variants are on the rise and have repeatedly threatened vaccines’ efficacy.

Dr. Enrique Garcia-Sayan, an assistant professor at UTHealth’s McGovern Medical School, told KHOU 11 that “The virus can actually damage the heart. And, it is important for people who have recovered and survived COVID to also be aware of any symptoms that may represent cardiovascular disease.”

Telltale signs of heart injury include chest pain, shortness of breath, and swelling in the ankles or legs. Garcia-Sayan said, “It is a really good opportunity to see a doctor and get checked up because you may need some specialized cardiac testing to look at the function of the heart chambers and look for any signs of damage from the COVID-19 virus.”

Greater risk with advanced age, severe disease

A meta-analysis study conducted by Chinese researchers was published on Dec. 31, 2020, in the Clinical Cardiology journal. Researchers scanned four databases from Dec. 2019 to July 15, 2020, and analyzed 21 studies with a total of 6297 participants to explore the prevalence and impact of cardiac injury in COVID-19 patients.

Cardiac injury was found in 22% of all hospitalized COVID-19 patients. The incidence of cardiac injury increased with age, as patients over 60 were twice as likely to have heart damage compared to patients under 60.

An empty hospital bed at Sacred Heart Medical Center in Spokane, WA on Dec. 4, 2005. COVID-19 patients with cardiac injury are at an increased risk of all-cause mortality. (Image: chrstphre via Flickr CC BY 2.0)

Severe COVID-19 cases (42 percent) were associated with a “seven-fold prevalence of cardiac injury” compared to their “non-severe counterparts (6 percent).” There was an over 900% increase in the odds of all-cause mortality. That’s in the case of patients with heart damage, with an odds ratio (OR) of 10.11.

The risk was even more pronounced in patients with severe COVID-19 and heart damage, with an OR of 16.79.

The authors concluded that cardiac injury is common in hospitalized COVID-19 patients, especially in those with advanced age and severe disease. Also, death from any cause is more likely to occur if a patient has heart damage.

Poorer outcomes increased ICU admission

Another meta-analysis conducted by a separate group of Chinese researchers was published in the Nutrition, Metabolism & Cardiovascular Diseases journal on Sep. 11, 2020. It delved more into the prognosis of COVID-19 patients with a cardiac injury.

The scientists scanned four databases for publications up until June 5, 2020. They implemented a rigorous screening process to finally arrive at 43 eligible studies for prevalence and 32 eligible studies for cardiac injury outcomes in COVID-19 patients.

This study’s key conclusions were consistent with the meta-analysis published in Clinical Cardiology. First, the “pooled prevalence of cardiac injury was 19% in all the COVID-19 patients, 36% in severe COVID-19 patients, and 48% in non-survivors.” Patients with more serious symptoms, including those who died, were more likely to have damage to the heart. Second, patients with cardiac injury had a five-fold higher risk of mortality.

Concerning clinical outcomes, the cardiac injury was associated with a significantly increased risk of poor outcomes, an increased risk of severe COVID-19 disease, and a five-fold increase in the likelihood of ICU admission. As a result, the authors recommended “more intensive attention and care” be paid to cardiac injury patients.

A histological slide showing a blood clot, consisting of red blood cells (red areas) and plasma mixed with white blood cells (pale areas). COVID-19 may increase the risk of blood clots, although additional studies are still needed. (Image: Pulmonary Pathology via Flickr CC BY-SA 2.0)

Long-term effects uncertain

The Washington Examiner reported a case of a young gentleman with three blocked arteries near his heart, which was highly unusual for his age despite his cardiovascular risk factors of obesity and having a sedentary lifestyle. Dr. Charles Mild, a cardiologist in Harlingen, TX, speculated it could have been an early case of COVID-19.

“I’ve never seen that before,” said Mild. The patient recovered after treatment, but this case “was before we were routinely looking for COVID by testing for it.” Many scientists, including Mild, believe that COVID-19 may induce a hypercoagulable state, in which blood clots are more likely to form.

International studies, including those from China, France, Italy, the Netherlands, and the U.S., have shown blood clots in both veins and arteries of COVID-19 patients. However, the long-term effects of COVID-19 on cardiovascular health are unknown.

According to Dr. Gregg Fonarow, co-chief of the cardiology division at the University of California at Los Angeles, “COVID-19 can increase the risk of blood clots, and if these clots form in the arteries to the heart, this can result in acute coronary syndromes. In addition, the increase in inflammation during COVID-19 can increase the vulnerability of preexisting plaques in the coronary arteries to rupture, which can also lead to [heart attack].”

Amid the COVID-19 pandemic, individuals should maintain healthy lifestyles conducive to maintaining heart health. Regular exercise, blood pressure monitoring, nutritious meals, and routine checkups with physicians are recommended.

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