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DOI:
ORIGINALPAPER
CARDIOVASCULARMEDICINE
Manifestationofcardiacinjuryinhospitalisedpatientswith
COVID-19­
Huolan Zhu1,2 |Yanfei Zhang1 |Zuowei Pei1 |Ying Guo1 |Chenguang Yang1 |
Yan Song1,3 |Xiaomei Guo3 |Fang Wang1,3
1DepartmentofCardiology,National
CenterofGerontology,InstituteofGeriatricAbstract
Medicine,BeijingHospital,ChineseBackground:COVID-­19hasbeensweepingtheworldsinceitemergedinlate
AcademyofMedicalSciences,Beijing,China
,littleisknownaboutcardiacinjuryinhospitalised
2PekingUnionMedicalCollege,Chinese
AcademyofMedicalScience,Beijing,ChinaCOVID-­
3TongjiHospital,Wuhan,ChinamyocardialinjuryinCOVID-­19patientsadmittedinhospital.
CorrespondenceMethods:Fifty-­fourCOVID-­19patientswereenrolledinonewardinTongjiHospital,
FangWang,DepartmentofCardiology,Wuhan,China,and5wereexcludedcausedbymissingcardiactroponinIlevels.
NationalCenterofGerontology,Instituteof
GeriatricMedicine,BeijingHospital,ChineseForty-­-
AcademyofMedicalSciences,,
,Beijing,100730,China.
Email:bjh_******@-­cardiacinjurygroup,basedonwhethercardiactroponin
Fundinginformation
The13thFive-­yearNationalScienceandthesetwogroup.
TechnologyMajorProject,Grant/AwardResults:Theaverageageofpatientsinthecardiacinjurygroupwasolder( years
Number:2017ZX09304026
old)thanthatinthenon-­cardiacinjurygroup( yearsold).Thepercentagesofpa-
tientswithdiabetesandcriticallyseverepneumoniainthecardiacinjurygroupwere
%%%ofallenrolled
patients,butthisdecreasewasmoreprominent(%)inthecardiacinjurygroup
thanthenon-­cardiacinjurygroup(%).Patientsinthecardiacinjurygroupalso
hadlowerplateletcounts.
Conclusions:COVID-­-
moninolderpatientsandpatientswithdiabetesandisassociatedwithasignificant
decreaseinlymphocytes.
What’known
AcomprehensiveunderstandingofCOVID-­19,theemergenthygeianissue,isessentialforits
-­19candamagevitalorgansandsystems,likecardiovascularsystem,inad-
ditiontotherespiratorysystem.
What’new
UnderstandingthemyocardialdamageofCOVID-­19isveryimportantforclinicianstocontrol
thisdisease.
Abbreviations:ALT,alanineaminotransferase;AST,aspartateaminotransferase;CK,creatinekinase;CK-­MB,creatinekinaseisoenzyme-­MB;cTnI,cardiactroponinI;ECMO,
extracorporealmembraneoxygenation;ESR,erythrocytesedimentationrate;NT-­BNP,N-­terminalbrainnatriureticpeptide;TC,totalcholesterol.
;00:©2021JohnWiley&SonsLtd | 1of8
/
2of8 | ZHUetal
1 | BACKGROUNDfunction,coagulationfunction,d-dimer,­C-­reactiveprotein,eryth-
rocytesedimentationrate(ESR),we
COVID-­19hasbeenspreadingwildlysinceitsoutbreakinlaterecordedthetestfindingscloselyrelatingtocardiacinjury:cardiac
December2019inWuhan,-troponinI(cTnI),Nterminalbrainnatriureticpeptide(NT-­BNP)and
ported,ithasbeenfoundthatCOVID-­19candamagemultiplesys-
-3­
patients,Cardiacinjuryisacommonconditionanditisassociateddurationwasdefinedasthedatefromsymptomdiscoverytohos-
withhigherriskofin-­-
diacinjuryoccurredin12%ofCOVID-­19patients,-
indicatedthatCOVID-­19patientswithcardiovasculardiseaseareatfinedas:mild:non-­pneumoniaormildpneumonia;severe:respira-
≥30/minute,bloodoxygensaturation≤93%,PaO2/
diseaseisapreciselydefined,-­19couldFiO2ratio[theratiobetweenarterialoxygenpartialpressureand
7
,itwasfractionalinspiredoxygen]<300and/orlunginfiltrates>50%within
alsofoundthatCOVID-­19causedseriouscardiacinjuryresultingin24to48 hours;orcriticallysevere:respiratoryfailure,septicshock
,itisimportanttoidentifycardiacdamagecausedand/
byCOVID-­,fewstudieshavebeenreportedcardiacin-Throatswabspecimenswereobtainedfromallpatients,and
jurybyCOVID-­19,andtheclinicalmanifestationsandmechanismsofCOVID-­19wastestedforbyRT-­
COVID-­19oncardiacinjuryarenotcompletelyclear,whereahugeThepresenceoftheCOVID-­19viruswasconfirmedinfourdifferent
,theChineseCenterforDiseaseControlandPrevention,
manifestationofcardiacinjuryinCOVID-­,ChineseAcademyofMilitary
-­PCRdetec-
moment,thereisnoeffectivetreatmentforCOVID-­19,onlysup-tionreagentswereprovidedbythesefourinstitutions.
,thisstudywouldhelpcliniciansunder-
standmoreaboutthediseaseandinterveneinthediseaseprocess
| Statisticalanalysis
Continuousvariablesarepresentedasmean(SD)ifnormallydistrib-
2 | METHODSutedandmedian(IQR)-
blesarepresentedasnumber(%).Aχ2testorFisher'sexacttestwas
| Patientsappliedtocompareparametersinthecardiacinjuryandnon-­cardiac
Thiswasasingle-­,COVID-­
HospitalfromFebruary10toFebruary23,-­19pa-
().
thepatients,andthepatients’writtenconsentswerewaived.
TongjiHospitalisthenationaldesignatedhospitalforadmissionof
COVID-­ | RESULTS
-­fourpatientswereenrolled,and5wereexcludedbecauseof
-
 years
|
patientsinthenon-­-
AllpatientswereunderthechargeofProfessorWangFang' yearsold,andthatofthenon-­cardiacin-
Werecordedthepatients'clinicalfeatures:age,sex,diseasehistory, 
onsetduration,exposurehistory,severity(mild,severeandcriti-groupsinonsetduration,
callysevere),diabetes,,theproportionofpatientswithcritically
Wealsorecordedthepatients'symptomsandresultsofphysicalseverepneumoniawassignificantlyhigherinthecardiacinjury
examination:fever,cough,sorethroat,fatigue,myalgia,headache,groupthanthatinthenon-­
diarrhoea,chestcongestion,shortnessofbreath,palpitation,bloodCOVID-­19pneumoniaoccurredin5of13patientsinthecardiacin-
pressure,-jurygroup(%)andin3of36patientsinthenon-­cardiacinjury
torytestswerealsorecorded:routinebloodtest,liverandkidneygroup(%).Therewasnodifferencebetweenthetwogroupsin
ZHUetal | 3of8
TABLE1 Baselinedemographic
AllpatientsCardiacinjuryNocardiacinjury
characteristicsofparticipants
Characteristic(n = 49)(n = 13)(n = 36)Pvalue
Age,years63(50-­68)68(-­76)(48-­66).007
Onsetduration,days10(5-­)7(4-­)10(7-­).375
Men31(%)9(%)22(%).743
Women18(%)4(%)14(%)
Exposurehistory18(%)3(%)15(%).322
COVID-­19severity
Mild20(%)5(%)15(%)–­
Severe21(%)3(%)18(50%).454
Criticalsevere8(%)5(%)3(%).023
Otherdisease14(%)6(%)8(%).152
Diabetes9(%)5(%)4(%).043
Hyperlipidaemia2(%)1(%)1(%).464
Hypertension22(%8(%)14(%).279
Cardiovasculardisease4(%)1(%)3(%)
TABLE2 Baselinedemographic
AllpatientsCardiacinjuryNocardiac
characteristicsofsignsandsymptoms
Characteristic(n = 49)(n = 13)injury(n = 36)P-­value
Fever38(%)9(%)29(%).451
Cough34(%)7(%)27(75%).178
Sorethroat5(%)2(%)3(%).598
Fatigue29(%)10(%)19(%).191
Myalgia13(%)2(%)11(%).467
Headache6(%)3(%)3(%).321
Diarrhoea11(%)1(%)10(%).246
Chestcongestion16(%)3(%)13(%).502
Shortnessofbreath16(%)3(%)13(%).502
Palpitation2(%)0(0%)2(%)
(-­)
(-­)(-­)
Respiratoryrate>245(%)3(%)2(%).109
breathsperminutes
occurrenceofchronicdiseasessuchashyperlipidaemia,hyperten-population,%ofpatents.
,therateofMoreover,reductioninlymphocytelevelswasfoundsignificantly
(%)thanthenon-­
cardiacinjury,5werediabetic(%)(Table 1).cardiacinjurygroup(%).Patientswithcardiacinjuryalsohad
%ofenrolledpatients,significantlyfewerplateletsthanpatientswithoutcardiacinjury.
%%%ofallpa-
%andpal-
%ofthestudypopulation,withnodiffer-decreasedin98%-dimer­%ofthe
,-­reactive
wasnosignificantdifferenceinthepercentageofpatientswithanyproteinandbloodsedimentationrateincreasedinpatientswithand
othersymptomsbetweenthetwogroups(Table 2).%%ofcasesrespectively.
Table 3(attheendofthetext)showsthelaboratorytestre-Serumelectrolytesandbloodglucoseshowednosignificantdiffer-
%inthewholeencesbetweenthetwogroups.
4of8 | ZHUetal
TABLE3 Baselinedemographiccharacteristicsoflaboratorytests
DetectingitemAllpatients(n = 49)Cardiacinjury(n = 13)Nocardiacinjury(n = 36)Pvalue
Leucocytes(109/L)(-­)(-­)(-­)(-­).892
Increased7(%)2(%)5(%)
Decreased12(%)2(%)9(%)
Lymphocyte(109/L)(-­)(-­)(-­)(-­).045
Decreased26(%)10(%)16(%)
Platelet(109/L)(125-­350)231(163-)­(-­)(-­).004
Increased14(%)1(%)13(%)
Decreased6(%)4(%)2(%)
Prothrombintime(s)(-­)14(-­)(-­)(-­).054
Increased12(%)5(%)7(%)
Fibrinogen(g/L)(-­)(-­)(-­)(-­).098
Increased35(%)6(%)29(%)
Decreased4(%)3(%)1(%)
Thromboplastintime(seconds)(75-­125)(-­)(-­)(-­).667
Increased1(%)1(%)0
Decreased48(%)12(%)36(100%)
d-­dimer(mg/L)(<)(-­)(-­)(-­).91
Increased39(%)11(%)28(%)
C-­reactivepr