Cardiovascular manifestations in severe and critical patients withCOVID-19
Cardiovascular manifestations in severe and critical patients withCOVID-19
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DOI：
10.1002/clc.23384
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发表时间：
2020-06-20
影响因子：
2.7
通讯作者：
Ge, Junbo
中科院分区：
文献类型：
--
作者：
Chen, Qingxing;Xu, Lili;Ge, Junbo
背景严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)可引起强毒力感染，导致新冠肺炎相关肺炎和多器官损害。假设新冠肺炎感染可能导致心血管症状，导致更差的临床结局。方法选择54例确诊为新冠肺炎的危重患者。分析预测新冠肺炎严重程度的危险因素。结果54例新冠肺炎患者(年龄56.1+/-13.5岁，男性66.7%)，重症39例，危重15例。危重病患者的糖尿病发生率、D-二聚体水平、炎症指标和心脏标志物水平明显高于危重病患者。肌钙蛋白I(TnI)升高的发生率为42.6%。3例患者入院时出现低血压，均被诊断为危重病例。住院期间发现1例重症患者和7例危重患者出现低血压。窦性心动过速是最常见的心律失常类型，23例重症患者和所有危重患者均可见窦性心动过速。危重病患者终末期以房室传导阻滞和室性心动过速为主，心动过缓和房颤较少。1例重度心包积液，5例危重心包积液。3例危重患者出现新的心力衰竭。治疗中低血压、严重心肌损伤和心包积液是预测新冠肺炎感染危重状态的独立危险因素。结论本研究系统观察了新冠肺炎对危重患者心血管系统的影响，包括对心肌损伤、血压、心律失常和心功能的影响。监测新冠肺炎患者的生命体征和心功能，并采取潜在的干预措施，特别是对那些在治疗过程中出现低血压、严重心肌损伤或心包积液的患者，具有至关重要的意义。
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could cause virulent infection leading to Corona Virus Disease 2019 (COVID-19)-related pneumonia as well as multiple organ injuries. Hypothesis COVID-19 infection may result in cardiovascular manifestations leading to worse clinical outcome. Methods Fifty four severe and critical patients with confirmed COVID-19 were enrolled. Risk factors predicting the severity of COVID-19 were analyzed. Results Of the 54 patients (56.1 +/- 13.5 years old, 66.7% male) with COVID-19, 39 were diagnosed as severe and 15 as critical cases. The occurrence of diabetes, the level of D-dimer, inflammatory and cardiac markers in critical cases were significantly higher. Troponin I (TnI) elevation occurred in 42.6% of all the severe and critical patients. Three patients experienced hypotension at admission and were all diagnosed as critical cases consequently. Hypotension was found in one severe case and seven critical cases during hospitalization. Sinus tachycardia is the most common type of arrythmia and was observed in 23 severe patients and all the critical patients. Atrioventricular block and ventricular tachycardia were observed in critical patients at end stage while bradycardia and atrial fibrillation were less common. Mild pericardial effusion was observed in one severe case and five critical cases. Three critical cases suffered new onset of heart failure. Hypotension during treatment, severe myocardial injury and pericardial effusion were independent risk factors predicting the critical status of COVID-19 infection. Conclusion This study has systemically observed the impact of COVID-19 on cardiovascular system, including myocardial injury, blood pressure, arrythmia and cardiac function in severe and critical cases. Monitoring of vital signs and cardiac function of COVID-19 patients and applying potential interventions especially for those with hypotension during treatment, severe myocardial injury or pericardial effusion, is of vital importance.