Suspected myocardial injury in patients with COVID-19: Evidence from front-line clinical observation in Wuhan, China
Suspected myocardial injury in patients with COVID-19: Evidence from front-line clinical observation in Wuhan, China
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COVID-19患者疑似心肌损伤：来自中国武汉一线临床观察的证据
DOI：
10.1016/j.ijcard.2020.03.087
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发表时间：
2020-07-15
影响因子：
3.5
通讯作者：
Zhou, Qing
中科院分区：
文献类型：
--
作者：
Deng, Qing;Hu, Bo;Zhou, Qing
背景资料：新型冠状病毒病（COVID-19）在武汉爆发，成为中国的重大公共卫生问题，引起国际社会的高度关注。心肌炎和心肌损伤被怀疑，甚至可能被认为是COVID-19患者死亡的主要原因之一。方法：回顾性收集2019年1月至2019年12月确诊为COVID-19患者的心脏相关临床资料，主要包括心脏影像学表现、实验室检查结果和临床转归。结果：112例COVID-19患者入组本研究。COVID-19患者中有心肌损伤的证据，14例（12.5%）患者出现类似心肌炎的异常。大部分患者入院时肌钙蛋白水平正常，42例（37.5%）患者住院期间肌钙蛋白水平升高，尤其是死亡患者。肌钙蛋白水平在死亡前一周显著升高。15例（13.4%）患者出现肺动脉高压体征。超声心动图和心电图上没有心肌炎的典型体征。结论：我们研究中的临床证据表明，心肌损伤更可能与全身后果有关，而不是2019年新型冠状病毒的直接损伤。心脏标志物的升高可能是由于继发性和全身性后果，可视为患者近期不良临床结局的警告信号。(c)2020 Elsevier B. V.保留所有权利。
Background: A novel coronavirus disease (COVID-19) inWuhan has caused an outbreak and become amajor public health issue in China and great concern from international community. Myocarditis and myocardial injury were suspected and may even be considered as one of the leading causes for death of COVID-19 patients. Therefore, we focused on the condition of the heart, and sought to provide firsthand evidence for whethermyocarditis and myocardial injury were caused by COVID-19.Methods: Weenrolled patientswith confirmed diagnosis of COVID-19 retrospectively and collected heart-related clinical data, mainly including cardiac imaging findings, laboratory results and clinical outcomes. Serial tests of cardiac markers were traced for the analysis of potential myocardial injury/myocarditis.Results: 112 COVID-19 patientswere enrolled in our study. Therewas evidence of myocardial injury in COVID-19 patients and 14 (12.5%) patients had presented abnormalities similar tomyocarditis. Most of patients had normal levels of troponin at admission, that in 42 (37.5%) patients increased during hospitalization, especially in those that died. Troponin levels were significantly increased in the week preceding the death. 15 (13.4%) patients have presented signs of pulmonary hypertension. Typical signs of myocarditiswere absent on echocardiography and electrocardiogram.Conclusions: The clinical evidence in our study suggested that myocardial injury is more likely related to systemic consequences rather than direct damage by the 2019 novel coronavirus. The elevation in cardiac markers was probably due to secondary and systemic consequences and can be considered as the warning sign for recent adverse clinical outcomes of the patients. (c) 2020 Elsevier B.V. All rights reserved.