scholarly journals Cardiac complications and pertaining mortality rate in COVID-19 patients; a systematic review and meta-analysis

2020 ◽  
Author(s):  
Amirmohammad Toloui ◽  
Donya Moshrefiaraghi ◽  
Arian Madani Neishaboori ◽  
Saeed Safari ◽  
Mahmoud Yousefifard ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Cardiac Arrest ◽  
Mortality Rate ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Cardiac Injury ◽  
Cardiac Complications ◽  
Troponin Level ◽  
Patient Assessments

Abstract Background Raising knowledge over cardiac complications and managing them can play a key role in their recovery. In this study, we aim to investigate the evidence regarding the prevalence of cardiac complications and the resulting mortality rate in COVID-19 patients. Results The initial search resulted in 853 records, from which 40 articles were included. Overall analysis showed the prevalence of acute cardiac injury, heart failure and cardiac arrest were 19.46% (95% CI: 18.23–20.72), 19.07% (95% CI: 15.38–23.04) and 3.44% (95% CI: 3.08–3.82), respectively. Moreover, abnormal serum troponin level was observed in 22.86% (95% CI: 21.19–24.56) of the COVID-19 patients. Further analysis revealed that the overall odds of mortality is 14.24 [odds ratio (OR) = 14.24; 95% CI: 8.67–23.38] times higher, when patients develop acute cardiac injury. The pooled odds ratio of mortality when the analysis was limited to abnormal serum troponin level was 19.03 (OR = 19.03; 95% CI: 11.85–30.56). Conclusion Acute cardiac injury and abnormal serum troponin level were the most prevalent cardiac complications/abnormalities in COVID-19 patients. The importance of cardiac complications becomes crucial due to the higher mortality rate among patients with these complications. Thus, troponin screenings and cardiac evaluations are recommended to be performed in routine patient assessments.

scholarly journals Cardiovascular Diseases and COVID-19 Mortality and Intensive Care Unit Admission: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Amir Shamshirian ◽  
Keyvan Heydari ◽  
Reza Alizadeh-Navaei ◽  
Mahmood Moosazadeh ◽  
Saeed Abrotan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Cardiovascular Disease ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Cardiovascular Diseases ◽  
Meta Analysis ◽  
Cardiac Injury ◽  
Icu Admission ◽  
The World

AbstractImportanceOn 11th March, the World Health Organization declared a pandemic of COVID-19. There are over 1 million cases around the world with this disease and it continues to raise. Studies on COVID-19 patients have reported high rate of cardiovascular disease (CVD) among them and patients with CVD had higher mortality rate.ObjectivesSince there were controversies between different studies about CVD burden in COVID-19 patients, we aimed to study cardiovascular disease burden among COVID-19 patients using a systematic review and meta-analysis.Data SourcesWe have systematically searched databases including PubMed, Embase, Cochrane Library, Scopus, Web of Science as well as medRxiv pre-print database. Hand searched was also conducted in journal websites and Google Scholar.Study SelectionStudies reported cardiovascular disease among hospitalized adult COVID-19 patients with mortality or ICU admission (primary outcomes) were included into meta-analysis. In addition, all of studies which reported any cardiovascular implication were included for descriptive meta-analysis. Cohort studies, case-control, cross-sectional, case-cohort and case series studies included into the study. Finally, 16 studies met the inclusion criteria for primary outcome and 59 studies for descriptive outcome.Data Extraction and SynthesisTwo investigators have independently evaluated quality of publications and extracted data from included papers. In case of disagreement a supervisor solved the issue and made the final decision. Quality assessment of studies was done using Newcastle-Ottawa Scale tool. Heterogeneity was assessed using I-squared test and in case of high heterogeneity (>%50) random effect model was used.Main Outcomes and MeasuresMeta-analyses were carried out for Odds Ratio (OR) of mortality and Intensive Care Unit (ICU) admission for different CVDs and Standardized Mean Difference (SMD) was calculated for Cardiac Troponin I. We have also performed a descriptive meta-analysis on different CVDs.ResultsSixteen papers including 3473 patients entered into meta-analysis for ICU admission and mortality outcome and fifty-nine papers including 9509 patients for descriptive outcomes. Results of meta-analysis indicated that acute cardiac injury, (OR: 15.94, 95% CI 2.31-110.14), hypertension (OR: 1.92, 95% CI 1.92-2.74), heart Failure (OR: 11.73, 95% CI 5.17-26.60), other cardiovascular disease (OR: 1.95, 95% CI 1.17-3.24) and overall CVDs (OR: 3.37, 95% CI 2.06-5.52) were significantly associated with mortality in COVID-19 patients. Arrhythmia (OR: 22.17, 95%CI 4.47-110.04), acute cardiac injury (OR: 19.83, 95%CI 7.85-50.13), coronary heart disease (OR: 4.19, 95%CI 1.27-13.80), cardiovascular disease (OR: 4.17, 95%CI 2.52-6.88) and hypertension (OR: 2.69, 95%CI 1.55-4.67) were also significantly associated with ICU admission in COVID-19 patients.ConclusionOur findings showed a high burden of CVDs among COVID-19 patients which was significantly associated with mortality and ICU admission. Proper management of CVD patients with COVID-19 and monitoring COVID-19 patients for acute cardiac conditions is highly recommended to prevent mortality and critical situations.Key PointsQuestionAre cardiovascular disease associated with mortality and Intensive Care Unit admission (ICU) of COVID-19 patients?FindingsIn this systematic review and meta-analysis, acute cardiac injury, hypertension, heart failure and overall cardiovascular diseases were significantly associated with mortality in COVID-19 patients. Arrhythmia, coronary heart disease, hypertension, acute cardiac injury and other cardiovascular disease were significantly associated with ICU admission of COVID-19 patients.MeaningCardiovascular diseases have significant role in mortality and disease severity of COVID-19 patients. COVID-19 patients need to be carefully monitored for cardiovascular diseases and managed properly in case of acute cardiac conditions.

scholarly journals Acute Cardiac Injury and COVID-19 – A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Husam M Salah ◽  
Angel Lopez Candales
Keyword(s):  
Systematic Review ◽  
Mortality Rate ◽  
Meta Analysis ◽  
Cardiac Injury ◽  
Case Series ◽  
Common Finding ◽  
Full Spectrum ◽  
Global Pandemic ◽  
Current Prevalence ◽  
Case Series Study

Abstract Introduction:The ongoing global pandemic, coronavirus disease 2019 (COVID-19), an illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has ranged from an asymptomatic state to unprecedented number of deaths worldwide. In symptomatic patients, a viral pneumonia can unrelentingly progress to multi-system failure with preferential cardiac tropism. Although the full spectrum of COVID-19 cardiac manifestations is still not clear; acute cardiac injury (ACI) remains a common finding. The goal of our study, not only is to examine the current prevalence of ACI among COVID-19 infected patients but also, the reported mortality.Method:After thoroughly searching the literature for appropriate studies, a systematic review and meta-analysis were performed. Inclusion criteria were 1) Cohort study, case-control study, or case series study. 2) The study population included individuals with COVID-19 3) The presence or absence of cardiac injury was reported in the study 4) Mortality among patients with cardiac injury is reported or can be calculated.Results:Ten studies were included with a total of 1664 patients. The prevalence of ACI was 30.8%. The mortality rate among patients with concurrent COVID-19 and ACI was 53%.Conclusion:ACI can occur in one third of patients with COVID-19. Concurrent COVID-19 and ACI entails a high mortality rate. Serum troponin level can be a good prognostic tool in COVID-19.

scholarly journals Acute cardiac injury in patients with COVID-19

2020 ◽  
Author(s):  
Andrea De Lorenzo ◽  
Daniel Kasal ◽  
Bernardo Tura ◽  
Cristiane Lamas ◽  
Helena Rey
Keyword(s):  
Systematic Review ◽  
Myocardial Injury ◽  
Meta Analysis ◽  
Cardiac Injury ◽  
Risk Of Bias ◽  
Cardiac Complications ◽  
Troponin Elevation ◽  
Study Heterogeneity ◽  
Life Threatening

Introduction: Cardiac complications of COVID-19 are potentially life-threatening. The occurrence of myocardial injury in the context of COVID-19 is multifactorial and has generated increasing interest. Methods: A systematic review with meta-analysis of the literature was performed. MEDLINE and EMBASE were searched. Two independente reviewers evaluated the selected manuscripts for the outcome myocardial injury, defined by troponin elevation above the 99th percentile. Study heterogeneity and risk of bias were evaluated. Results: Eight studies, with a total of 1229 patients, were included. The frequency of myocardial injury was 16% (95% CI: 9% - 27%). The heterogeneity among studies was high (93%). Conclusions: Myocardial injury may occur in patients with COVID-19, with a frequency of 16% among current studies. Continuous research is needed to update these findings, as the pandemic evolves, and to define the implications of myocardial injury in the context of this infection.

scholarly journals Cognitive impairment associated with increased mortality rate in patients with heart failure: A systematic review and meta-analysis

2019 ◽  
Vol 31 (4) ◽  
pp. 170-178 ◽  
Author(s):  
Jakrin Kewcharoen ◽  
Narut Prasitlumkum ◽  
Chanavuth Kanitsoraphan ◽  
Nattawat Charoenpoonsiri ◽  
Natthapon Angsubhakorn ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Cognitive Impairment ◽  
Mortality Rate ◽  
Meta Analysis ◽  
Patients With Heart Failure

scholarly journals Effect of Tocilizumab in Reducing the Mortality Rate in COVID-19 Patients: A Systematic Review with Meta-Analysis

2021 ◽  
Vol 11 (7) ◽  
pp. 628
Author(s):  
Valeria Conti ◽  
Graziamaria Corbi ◽  
Carmine Sellitto ◽  
Francesco Sabbatino ◽  
Chiara Maci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mortality Rate ◽  
Critically Ill Patients ◽  
Odds Ratio ◽  
Observational Studies ◽  
Meta Analysis ◽  
Regression Analyses ◽  
Log Odds ◽  
Meta Regression ◽  
Reduction Of Mortality

Data supporting the use of Tocilizumab (TCZ) in COVID-19 are contrasting and inconclusive. This meta-analysis aimed to assess TCZ effectiveness in reducing the mortality rate in COVID-19 patients. PubMed, Scopus, Embase, Cochrane, WILEY, and ClinicalTrials.gov were searched to evaluate observational studies and RCTs. The outcome was the mortality rate. Forty observational studies and seven RCTs, involving 9640 and 5556 subjects treated with Standard Therapy (ST) + TCZ or ST alone, respectively, were included. In patients treated with ST+TCZ, a higher survival (Log odds ratio = −0.41; 95% CI: −0.68 −0.14; p < 0.001) was found. Subgroups analyses were performed to better identify the possible interference of some parameters in modifying the efficacy of TCZ therapy on COVID-19 mortality. Separating observational from RCTs, no statistically significant (p = 0.70) TCZ-related reduction of mortality regarding RCTs was found, while a significant reduction (Log odds ratio = −0.52; 95% CI: −0.82 −0.22, p < 0.001) was achieved regarding the observational studies. Stratifying for the use of Invasive Mechanic Ventilation (IMV), a higher survival was found in patients treated with TCZ in the No-IMV and IMV groups (both p < 0.001), but not in the No-IMV/IMV group. Meta-regression analyses were also performed. The meta-analysis of observational studies reveals that TCZ is associated with reducing the mortality rate in both severe and critically ill patients. Although the largest RCT, RECOVERY, is in line with this result, the meta-analysis of RCTs failed to found any difference between ST + TCZ and ST. It is crucial to personalize the therapy considering the patients’ characteristics.

scholarly journals Acute Cardiac Injury in COVID-19: A Systematic Review and Meta-analysis

2020 ◽  
Vol 23 (11) ◽  
pp. 801-812
Author(s):  
Mehrbod Vakhshoori ◽  
Maryam Heidarpour ◽  
Davood Shafie ◽  
Marzieh Taheri ◽  
Nima Rezaei ◽  
...  
Keyword(s):  
Systematic Review ◽  
Myocardial Injury ◽  
Meta Analysis ◽  
Clinical Status ◽  
Cardiac Injury ◽  
Cardiac Biomarkers ◽  
Cardiac Complications ◽  
The Mean ◽  
Cardiac Manifestations

Background: Coronavirus disease 2019 (COVID-19) has been widespread since late December 2019, with several symptoms related to the upper and lower respiratory system. However, its cardiac manifestations are less frequently studied. We aimed to analyze the available COVID-19 data on acute cardiac injury, using troponin and brain natriuretic peptide (BNP) levels. Methods: We performed a systematic review on Medline/PubMed, Scopus, and Google Scholar databases until March 25, 2020. Relevant records reporting the incidence of acute cardiac injury as well as troponin and BNP levels were collected from published peer-reviewed articles with further analysis according to the clinical status of the patients (severe, non-severe, and death). Results: Eleven records of 1394 individuals were included. The mean age of patients with acute cardiac injury was 56.6 ± 33.4 years (males: 54.3%). The incidence of acute cardiac injury was 15% (95% CI: 11, 20%). Further analysis revealed that dead or severe patients had significantly higher percentages of myocardial injury, compared to non-severe ones (peer-reviewed: 44%, 95% CI: 16, 74% vs. 24%, 95% CI: 15, 34% vs. 5%, 95% CI: 1, 12%, respectively). Mean total troponin was 10.23 pg/mL (95% CI: 5.98, 14.47), while 13% (95% CI: 8%, 18%) of patients had elevated levels. Mean BNP was 216.74 pg/mL (95% CI: 3.27, 430.20). Conclusion: Acute cardiac injury in COVID-19 patients is more frequent than what was expected at the beginning of the outbreak. Meanwhile, further studies are needed to investigate the utility of cardiac biomarkers as diagnostic and prognostic tools for long-term cardiac complications of this infection.

scholarly journals Heart failure in childhood cancer survivors – A systematic review protocol

2021 ◽  
Author(s):  
Tove Berg ◽  
Jens Böhmer ◽  
Bright Nwaru ◽  
Kristjan Karason ◽  
Marianne Jarfelt
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Cancer Survivors ◽  
Childhood Cancer ◽  
Meta Analysis ◽  
Public Health Practice ◽  
Childhood Cancer Survivors ◽  
Population Based ◽  
Cardiac Complications ◽  
Treatment Protocols

Abstract BackgroundOver the past decades, survival rate for childhood cancer has greatly improved. However, the risk of late cardiac complications after such treatment remains high. Previous studies have shown that the risk for heart failure among childhood cancer survivors is significantly higher than that observed in the general population. The aim of this systematic review is to identify, critically appraise and synthesize existing population-based studies reporting on the frequency of heart failure, both incidence or prevalence, that may develop after treatment of childhood cancer.Method:The following databases will be searched from their inception date until May 17th 2021: Medline, Embase, Scopus, CINAHL, CAB International, AMED, Global Health, Psycinfo, Web of science and Google Scholar. Population-based studies reporting on the incidence and/or prevalence of heart failure after treatment of any type of childhood cancer will be included. Screening of articles, data extraction and quality assessment will be performed independently by two reviewers. The quality and risk of bias in the studies included will be assessed by using the Effective Public Health Practice Project tool. A narrative synthesis of the extracted data will be undertaken and, for studies that are sufficiently homogenous, a meta-analysis using random-effects models performed.DiscussionThis systematic review will provide a clearer picture of the epidemiology of heart failure after treatment of childhood cancer. Collected data will be of value for future childhood cancer treatment protocols and also offer guidance for post-treatment cardiac surveillance among survivors.Systematic review registrationThis protocol follows the structure of the recommendation of the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) and has been submitted in PROSPERO on April 28th 2021, awaiting assignment of registration number.

scholarly journals Cardiac Injury Biomarkers and the Risk of Death in Patients with COVID-19: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Sami H. Alzahrani ◽  
Mohammed W. Al-Rabia
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Cardiac Injury ◽  
Significant Rise ◽  
Cardiac Complications ◽  
Close Monitoring ◽  
Reference Limit ◽  
Risk Of Death ◽  
Increased Risk ◽  
Upper Reference Limit

Background. Cardiac complications may develop in a proportion of patients with the novel coronavirus disease (COVID-19), which may influence their prognosis. Objectives. To assess the role of cardiac injury biomarkers measured on admission and during hospitalization as risk factors for subsequent death in COVID-19 patients. Methods. A systematic review and meta-analysis was carried out involving cohort studies that compared the levels of cardiac injury biomarkers in surviving and dead COVID-19 patients. Cardiac injury is defined as an elevation of the definitive markers (cardiac troponin (cTnI and cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP)) above the 99th percentile upper reference limit. Secondary markers included creatine kinase-myocardial bound (CK-MB), myoglobin, interleukin-6 (IL-6), and C-reactive protein (CRP). The risk of death and the differences in marker concentrations were analyzed using risk ratios (RRs) and standardized mean differences (SMDs), respectively. Results. Nine studies met the inclusion criteria (1799 patients, 53.36% males, 20.62% with cardiac injury). The risk of death was significantly higher in patients with elevated cTn than those with normal biomarker levels (RR = 5.28, P < 0.0001 ). Compared to survivors, dead patients had higher levels of cTn (SMD = 2.15, P = 0.001 ), IL-6 (SMD = 3.13, P = 0.03 ), hs-CRP (SMD = 2.78, P < 0.0001 ), and CK-MB (SMD = 0.97, P < 0.0001 ) on admission and a significant rise of plasma cTnT during hospitalization. Conclusion. COVID-19 patients with elevated cTn on admission, possibly due to immune-mediated myocardial injury, are at increased risk for mortality. This requires further radiographic investigations, close monitoring, and aggressive care to reduce the risk of severe complications and death.

scholarly journals Cardiac Adverse Events of Immune Checkpoint Inhibitors in Oncology Patients: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Nso Nso Vialli ◽  
Daniel Antwi-Amoabeng ◽  
Bryce D. Beutler ◽  
Mark B. Ulanja ◽  
Jasmine Ghuman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Systematic Review ◽  
Cardiac Arrest ◽  
Pericardial Effusion ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Meta Analysis ◽  
Risk Of Bias

AbstractBackgroundImmune checkpoint inhibitors (ICIs) are novel therapeutic agents used for various types of cancer. ICIs have revolutionized cancer treatment and improved clinical outcomes among cancer patients. However, immune-related adverse effects of ICI therapy are common. Cardiovascular immune-related adverse events (irAEs) are rare but potentially life-threatening complications. We aimed to estimate the incidence of cardiovascular irAEs among patients undergoing ICI therapy for various malignancies.MethodsWe conducted this systematic review and meta-analysis by searching PubMed, Cochrane CENTRAL, Web of Science, and SCOPUS databases for relevant interventional trials reporting cardiovascular irAEs. We performed a single-arm meta-analysis using OpenMeta [Analyst] software of the following outcomes: myocarditis, pericardial effusion, heart failure, cardiomyopathy, atrial fibrillation, myocardial infarction, and cardiac arrest. We assessed the heterogeneity using the I2 test and managed to solve it with Cochrane’s leave-one-out method. The risk of bias was performed with the Cochrane’s risk of bias tool.ResultsA total of 26 studies were included. The incidence of irAEs follows: myocarditis: 0.5% (95% CI [0.1%-0.9%]); pericardial effusion: 0.5% (95% CI [0.1%-1.0%]); heart failure: 0.3% (95% CI [0.0%-0.5%]); cardiomyopathy: 0.3% (95% CI [-0.1%-0.6%]); atrial fibrillation: 7.6% (95% CI [1.0%-14.1%]); myocardial infarction: 0.4% (95% CI [0.0%-0.7%]); and cardiac arrest: 0.4% (95% CI [0.1%-0.8%]).ConclusionThe most common cardiovascular irAEs were atrial fibrillation, myocarditis, and pericardial effusion. Although rare, data from post market surveillance will provide estimates of the long-term prevalence and prognosis in patients with ICI-associated cardiovascular complications.

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