Department of Medical Ultrasonics, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, NO. 29 Bulan Road, Shenzhen, 518112, People's Republic of China.
Department of Infectious Disease, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, NO. 29 Bulan Road, Shenzhen, 518112, People's Republic of China.
Infection. 2020 Dec;48(6):861-870. doi: 10.1007/s15010-020-01473-w. Epub 2020 Jul 28.
The coronavirus disease 2019 (COVID-19) outbreak has become a global public health concern; however, relatively few detailed reports of related cardiac injury are available. The aims of this study were to compare the clinical and echocardiographic characteristics of inpatients in the intensive-care unit (ICU) and non-ICU patients.
We recruited 416 patients diagnosed with COVID-19 and divided them into two groups: ICU (n = 35) and non-ICU (n = 381). Medical histories, laboratory findings, and echocardiography data were compared.
The levels of myocardial injury markers in ICU vs non-ICU patients were as follows: troponin I (0.029 ng/mL [0.007-0.063] vs 0.006 ng/mL [0.006-0.006]) and myoglobin (65.45 μg/L [39.77-130.57] vs 37.00 μg/L [26.40-53.54]). Echocardiographic findings included ventricular wall thickening (12 [39%] vs 1 [4%]), pulmonary hypertension (9 [29%] vs 0 [0%]), and reduced left-ventricular ejection fraction (5 [16%] vs 0 [0%]). Overall, 10% of the ICU patients presented with right heart enlargement, thickened right-ventricular wall, decreased right heart function, and pericardial effusion. Cardiac complications were more common in ICU patients, including acute cardiac injury (21 [60%] vs 13 [3%]) (including 2 cases of fulminant myocarditis), atrial or ventricular tachyarrhythmia (3 [9%] vs 3 [1%]), and acute heart failure (5 [14%] vs 0 [0%]).
Myocardial injury marker elevation, ventricular wall thickening, pulmonary artery hypertension, and cardiac complications including acute myocardial injury, arrhythmia, and acute heart failure are more common in ICU patients with COVID-19. Cardiac injury in COVID-19 patients may be related more to the systemic response after infection rather than direct damage by coronavirus.
2019 年冠状病毒病（COVID-19）疫情已成为全球关注的公共卫生问题，但相关心脏损伤的详细报告相对较少。本研究旨在比较重症监护病房（ICU）和非 ICU 住院患者的临床和超声心动图特征。
我们招募了 416 名确诊为 COVID-19 的患者，并将他们分为两组：ICU 组（n=35）和非 ICU 组（n=381）。比较了两组患者的病史、实验室检查和超声心动图数据。
与非 ICU 患者相比，ICU 患者的心肌损伤标志物水平如下：肌钙蛋白 I（0.029ng/mL[0.007-0.063] vs 0.006ng/mL[0.006-0.006]）和肌红蛋白（65.45μg/L[39.77-130.57] vs 37.00μg/L[26.40-53.54]）。超声心动图表现包括心室壁增厚（12[39%] vs 1[4%]）、肺动脉高压（9[29%] vs 0[0%]）和左心室射血分数降低（5[16%] vs 0[0%]）。总体而言，10%的 ICU 患者出现右心增大、右心室壁增厚、右心功能下降和心包积液。与非 ICU 患者相比，ICU 患者更易发生心脏并发症，包括急性心肌损伤（21[60%] vs 13[3%]）（包括 2 例暴发性心肌炎）、房性或室性心动过速（3[9%] vs 3[1%]）和急性心力衰竭（5[14%] vs 0[0%]）。
与 COVID-19 非 ICU 患者相比，COVID-19 ICU 患者心肌损伤标志物升高、心室壁增厚、肺动脉高压以及急性心肌损伤、心律失常和急性心力衰竭等心脏并发症更为常见。COVID-19 患者的心脏损伤可能更多地与感染后全身反应有关，而不是冠状病毒的直接损伤。
