Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan 430060, China.
Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China.
Int J Cardiol. 2020 Jul 15;311:116-121. doi: 10.1016/j.ijcard.2020.03.087. Epub 2020 Apr 8.
A novel coronavirus disease (COVID-19) in Wuhan has caused an outbreak and become a major 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 whether myocarditis and myocardial injury were caused by COVID-19.
We enrolled patients with 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.
112 COVID-19 patients were enrolled in our study. There was evidence of myocardial injury in COVID-19 patients and 14 (12.5%) patients had presented abnormalities similar to myocarditis. 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 myocarditis were absent on echocardiography and electrocardiogram.
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.
武汉发生的新型冠状病毒疾病（COVID-19）引发了疫情，成为中国的重大公共卫生问题，并引起国际社会的高度关注。疑似心肌炎和心肌损伤，甚至可能被认为是 COVID-19 患者死亡的主要原因之一。因此，我们关注心脏状况，并试图为心肌炎和心肌损伤是否由 COVID-19 引起提供第一手证据。
我们回顾性地招募了确诊为 COVID-19 的患者，并收集了与心脏相关的临床数据，主要包括心脏影像学发现、实验室结果和临床结局。对心脏标志物进行了连续测试，以分析潜在的心肌损伤/心肌炎。
本研究共纳入 112 例 COVID-19 患者。COVID-19 患者存在心肌损伤的证据，其中 14 例（12.5%）患者表现出类似心肌炎的异常。大多数患者入院时肌钙蛋白水平正常，42 例（37.5%）患者在住院期间升高，尤其是死亡患者。在死亡前一周，肌钙蛋白水平显著升高。15 例（13.4%）患者出现肺动脉高压迹象。超声心动图和心电图均未见典型心肌炎表现。
本研究的临床证据表明，心肌损伤更可能与全身后果有关，而不是与 2019 年新型冠状病毒的直接损害有关。心脏标志物的升高可能是继发和全身性后果所致，可作为患者近期不良临床结局的预警信号。
